Archived case 222 · May 16-May 23, 2017
Inflammatory bowel disease associated pulmonary disease
A 23-year-old caucasian male presents with chronic productive cough. Past medical history is withheld
The question posed to readers
What are the pertinent findings on the contrast-enhanced CT images?
Imaging findings
There is diffuse soft tissue thickening of the tracheal and bornchial walls. There is lower lung zone-predominant cylindrical to mild varicoid bronchiectasis. Peribronchial ground glass opacities are noted in the lung bases. Answer Diagnosis: Inflammatory bowel disease associated pulmonary disease
Diagnosis
Inflammatory bowel disease associated pulmonary disease
Differential diagnosis:
Infections causing bronchiectasis (e.g. nontuberculous mycobacterial infections)
Drug related pulmonary disease
Amyloidosis
Variant cystic fibrosis
This patient has a past medical history of Ulcerative Colitis.
Radiological presentations of interstitial lung involvement are quite diverse. Amongst those are tracheobronchial pathology. This includes bronchiectasis, tracheal wall thickening, tracheal stenosis and cellular and constrictive bronchiolitis. Best imaging tool for evaluation of concomitant pulmonary disease is high-resolution or thin-section CT of the chest. Exacerbation of respiratory symptoms often develop in patients with active IBD. The treatment for IBD-associated pulmonary disease is steroids.
Reference:
· Pulmonary manifestations of inflammatory bowel disease. Majewski S, et al. Arch Med Sci . 2015 Dec 10; 11(6): 1179–1188.
Pulmonary manifestations of inflammatory bowel disease. Ji X-Q, et al. World Journal of Gastroenterology . 2014 Oct 7; 20(37): 13501–13511.Original case written by its authors at Virginia Commonwealth University and published at this address as part of a weekly teaching collection. Reproduced here as an archive.