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Inexplicable Dyspnea in a Soldier: Constrictive Bronchiolitis
Description
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A6758 - Inexplicable Dyspnea in a Soldier: Constrictive Bronchiolitis
Author Block: K. Lemma1, I. Milojevic1, K. Vyas1, E. Paal2; 1Pulmonary and Critical Care Medicine, Washington DC Veterans Affairs Medical Center, Washington, DC, United States, 2Pathology and Laboratory Medicine, Washington DC Veterans Affairs Medical Center, Washington, DC, United States.
IntroductionBronchiolitis comprises a broad group of inflammatory diseases affecting bronchioles (small airways lacking cartilage walls). Constrictive bronchiolitis (CB) is a patho-histological correlate of bronchiolitis obliterans (BOS) clinical syndrome. It is characterized by circumferential submucosal fibrous tissue proliferation causing bronchiolar lumen narrowing, which may progress to complete obliteration of the bronchiole. There are several causes that have been recognized including lung transplantation, post–infectious inflammation, rheumatologic diseases and inhalation injury. We report a case of a soldier who developed Constrictive Bronchiolitis after serving in Iraq.
Case ReportA 30 year old non-smoker woman presented to the pulmonary clinic with history of progressive dyspnea for the past 5 years. She was previously very active and participated in marathons and other physical activities. She was now unable to walk more than 2 blocks without rest. She was deployed to Iraq in 2008 and served for about 2 years. She reported exposure to burn pit. As part of her evaluation, she had a CT scan of the chest which showed no abnormalities. Pulmonary function testing showed no obstruction but showed a restriction with decreased lung capacity. She subsequently underwent a VATS with wedge biopsy. Pathology showed focal chronic peri-bronchial lymphocytic infiltration and fibrosis consistent with CB.
Discussion
Constrictive Bronchiolitis secondary to burn pit exposure remains challenging to diagnose. CT scan of the chest is typically normal but may show evidence of air-trapping on expiratory imaging. Pulmonary function tests are typically normal or non-specific. Biopsy is often required for definitive diagnosis although there is no effective treatment thus far.
Dyspnea is a common complaint among soldiers who return from deployment. Constrictive Bronchiolitis should be considered especially if imaging studies and physiologic studies are unrevealing.
Author Block: K. Lemma1, I. Milojevic1, K. Vyas1, E. Paal2; 1Pulmonary and Critical Care Medicine, Washington DC Veterans Affairs Medical Center, Washington, DC, United States, 2Pathology and Laboratory Medicine, Washington DC Veterans Affairs Medical Center, Washington, DC, United States.
IntroductionBronchiolitis comprises a broad group of inflammatory diseases affecting bronchioles (small airways lacking cartilage walls). Constrictive bronchiolitis (CB) is a patho-histological correlate of bronchiolitis obliterans (BOS) clinical syndrome. It is characterized by circumferential submucosal fibrous tissue proliferation causing bronchiolar lumen narrowing, which may progress to complete obliteration of the bronchiole. There are several causes that have been recognized including lung transplantation, post–infectious inflammation, rheumatologic diseases and inhalation injury. We report a case of a soldier who developed Constrictive Bronchiolitis after serving in Iraq.
Case ReportA 30 year old non-smoker woman presented to the pulmonary clinic with history of progressive dyspnea for the past 5 years. She was previously very active and participated in marathons and other physical activities. She was now unable to walk more than 2 blocks without rest. She was deployed to Iraq in 2008 and served for about 2 years. She reported exposure to burn pit. As part of her evaluation, she had a CT scan of the chest which showed no abnormalities. Pulmonary function testing showed no obstruction but showed a restriction with decreased lung capacity. She subsequently underwent a VATS with wedge biopsy. Pathology showed focal chronic peri-bronchial lymphocytic infiltration and fibrosis consistent with CB.
Discussion
Constrictive Bronchiolitis secondary to burn pit exposure remains challenging to diagnose. CT scan of the chest is typically normal but may show evidence of air-trapping on expiratory imaging. Pulmonary function tests are typically normal or non-specific. Biopsy is often required for definitive diagnosis although there is no effective treatment thus far.
Dyspnea is a common complaint among soldiers who return from deployment. Constrictive Bronchiolitis should be considered especially if imaging studies and physiologic studies are unrevealing.
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