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Imaging of Small Airways Disease

Abbott, Gerald F. MD*; Rosado-de-Christenson, Melissa L. MD† ‡ §; Rossi, Santiago E. MD; Suster, Saul MD

doi: 10.1097/RTI.0b013e3181c1ab83

Small airways disease includes a spectrum of inflammatory and fibrotic pulmonary diseases centered on the small conducting airways. High-resolution computed tomography plays a key role in the detection and classification of small airways disease and, when combined with relevant clinical and pathologic findings, leads to a more accurate diagnosis. The imaging manifestations of small airways disease on high-resolution computed tomography may be direct or indirect signs of small airway involvement and include centrilobular nodules and branching nodular (tree-in-bud) opacities, or the demonstration of mosaic attenuation that is typically exaggerated on expiratory computed tomography. This article reviews the normal anatomy and histology of bronchioles and the clinical, pathologic, and imaging features of small airways diseases.

*Department of Radiology, Massachusetts General Hospital, Boston, MA

§Department of Radiology and Nuclear Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD

Department of Radiology, Saint Luke's Hospital of Kansas City

Department of Radiology, University of Missouri-Kansas City, Kansas City, MO

Department of Radiology, Centro de Diagnóstico Dr. Enrique Rossi, Buenos Aires, Argentina

Department of Pathology and Laboratory Medicine, Medical College of Wisconsin, Milwaukee, WI

Reprints: Gerald F. Abbott, MD, Department of Radiology, Massachusetts General Hospital, Thoracic Radiology-FND 202, 55 Fruit Street, Boston, MA 02114-2696 (e-mail: GABBOTT@PARTNERS.ORG).

© 2009 Lippincott Williams & Wilkins, Inc.