Exudative cellular bronchiolitis...?

Posted by zoelife @zoelife, Feb 9 6:56am

Question: what percentage of patients with the following scenario should get a bronchoscopy biopsy to view the pathology to best determine diagnosis? This is for someone who accidentally aspirated food or liquid in mid December and since have had constant itchiness in lungs and shortness of breath (worst side effects have been difficulty finishing a sentence without running out of breath feeling like suffocating from inside). The itch at times has been very intense with no way known yet on how to alleviate it. They have also found walking a few blocks in temperatures lower than 55 degrees to exacerbate things on a few occasions.

The first Pulmonologist they saw did not find bronchiectasis but I don’t believe they even considered the exudative form of cellular bronchiolitis. Next will be a second opinion at a different facility next week.

Scenario: patient had an aspiration event with subsequent findings:
Clinical findings: itchiness in lungs, shortness of breath (no wheezing or coughing).

Radiological findings:
Tree in bud and signet ring opacities.
Centrilobular nodules:
Left lung has 3 calcified granulomas measuring up to 5mm.
Right lung has 6 non calcified nodules measuring up to 3mm. Also, left infrahilar calcified granuloma measuring 7mm.

Also, what kind of treatment options have been seen as effective for exudative cellular bronchiolitis (if applicable)?

Links to a few videos used for reference:
> youtu.be/muuv-Efkdkw
> youtu.be/l5HKSJZNh7w
> youtu.be/YYn1RKJ3pyA

@zoelife– Welcome to Mayo Clinic Connect. We are patients helping other patients and not in the medical field. I am not in the medical field and have had lots of lung tests because of lung cancer. I bet that this is uncomfortable or even painful. I also have a tree in bud formation in one of my lungs. Tree in bud and signet rings are an indication of an infection and usually occur in the centrilobular nodules.

From what little I have read about this a sample of mucus can determine if someone has bronchiolitis along with listening to lung signs. A bronchoscopy may make your symptoms worse or introduce bacteria and really complicate things. Bronchiolitis is typically caused by a virus so antibiotics aren't used.

I can't tell you what percentage of patients should get a bronchoscopy biopsy for this condition. Also percentages, I find, are unreliable as diagnostic tools or treatments. The nodules can also be seen as part of the infection. I am glad that you are getting a second opinion. Have you been given any inhalers or anti-inflammatories to help?

Have your
https://www.mayoclinic.org/diseases-conditions/bronchiolitis/diagnosis-treatment/drc-20351571

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@merpreb

@zoelife– Welcome to Mayo Clinic Connect. We are patients helping other patients and not in the medical field. I am not in the medical field and have had lots of lung tests because of lung cancer. I bet that this is uncomfortable or even painful. I also have a tree in bud formation in one of my lungs. Tree in bud and signet rings are an indication of an infection and usually occur in the centrilobular nodules.

From what little I have read about this a sample of mucus can determine if someone has bronchiolitis along with listening to lung signs. A bronchoscopy may make your symptoms worse or introduce bacteria and really complicate things. Bronchiolitis is typically caused by a virus so antibiotics aren't used.

I can't tell you what percentage of patients should get a bronchoscopy biopsy for this condition. Also percentages, I find, are unreliable as diagnostic tools or treatments. The nodules can also be seen as part of the infection. I am glad that you are getting a second opinion. Have you been given any inhalers or anti-inflammatories to help?

Have your
https://www.mayoclinic.org/diseases-conditions/bronchiolitis/diagnosis-treatment/drc-20351571

Jump to this post

@zoelife Their symptoms sound extremely difficult to manage and I hope they will soon find answers, treatment, and relief.

I'd like to extend my welcome to Mayo Clinic Connect and concur with @merpreb that members are not medically trained but they are here to support and share their experiences. It sounds like @merpreb has a lot of experience on this topic.

I'd like to invite members like @bizzy12 @nla4625 @fracturedd @oakbourne @spudmato @janeellen @lori01 @hopeful33250 to join the conversation, as they have recently discussed Lung Health and may be able to offer support on this journey.

I also think it is good you are getting a second opinion.

May I ask if the second opinion is at a specialty or teaching hospital?

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@zoelife Hello, have they tested the mucus to rule out infection? I'm sure they requested a follow up scan in 6 months to keep an eye on the nodules- that's usually helpful. Also, maybe the breathlessness can be a side effect of silent heartburn/acid reflux/gerd… Bronchoscopy is last resort I would think or hope, but that's just my opinion. Second opinions are always a good idea!

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@merpreb

@zoelife– Welcome to Mayo Clinic Connect. We are patients helping other patients and not in the medical field. I am not in the medical field and have had lots of lung tests because of lung cancer. I bet that this is uncomfortable or even painful. I also have a tree in bud formation in one of my lungs. Tree in bud and signet rings are an indication of an infection and usually occur in the centrilobular nodules.

From what little I have read about this a sample of mucus can determine if someone has bronchiolitis along with listening to lung signs. A bronchoscopy may make your symptoms worse or introduce bacteria and really complicate things. Bronchiolitis is typically caused by a virus so antibiotics aren't used.

I can't tell you what percentage of patients should get a bronchoscopy biopsy for this condition. Also percentages, I find, are unreliable as diagnostic tools or treatments. The nodules can also be seen as part of the infection. I am glad that you are getting a second opinion. Have you been given any inhalers or anti-inflammatories to help?

Have your
https://www.mayoclinic.org/diseases-conditions/bronchiolitis/diagnosis-treatment/drc-20351571

Jump to this post

Thanks for taking the time to provide this feedback, Merry. Is appreciated.

The patient reported discomfort during the moments the itchiness got intense with no way to alleviate it. The shortness of breath has more less been an inconvenience more than anything. One of their hobbies is singing and this has made it difficult for them. But they did say that as Iong as they have breath in their lungs they will never stop singing, which was good to hear.

The cause was aspiration and not a virus. I have read how some physicians are able to make a definitive diagnosis without doing a bronchoscopy, however it seems getting the pathology from a bronchoscopy could have its benefits of knowing exactly what one is dealing with and the best treatment options.

As to your questions, the patient was given 5 days worth of methylprednisone (steroid anti inflammatory) in mid January, which didn’t seem to make a difference. The issue breathing hasn’t caused them to need an inhaler as the shortness of breath symptoms have been entirely different than asthmatic symptoms. They say this with assuredness because the asthma they had as a child (causing hospitalization and being put in an incubator for a few weeks) by God’s grace they recovered from at age 18. Patient hasn’t needed an inhaler since.

The first Doctor they saw had them take albuterol via a nebulizer as part of the pulmonary function test but it felt like it made things worse causing them to cough mucus for the next hour. Also, it didn’t alleviate the itchy lungs at all. As to relieving the shortness of breath, it helped maybe 2%. To clarify, all symptoms came a day after they accidentally choked and then aspirated.

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@erikas

@zoelife Their symptoms sound extremely difficult to manage and I hope they will soon find answers, treatment, and relief.

I'd like to extend my welcome to Mayo Clinic Connect and concur with @merpreb that members are not medically trained but they are here to support and share their experiences. It sounds like @merpreb has a lot of experience on this topic.

I'd like to invite members like @bizzy12 @nla4625 @fracturedd @oakbourne @spudmato @janeellen @lori01 @hopeful33250 to join the conversation, as they have recently discussed Lung Health and may be able to offer support on this journey.

I also think it is good you are getting a second opinion.

May I ask if the second opinion is at a specialty or teaching hospital?

Jump to this post

Thanks for your reply, Erika. The 2nd opinion will be at a teaching hospital – at UC Jacobs. Thanks for adding others to join in the conversation. I appreciate your helpfulness.

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@fracturedd

@zoelife Hello, have they tested the mucus to rule out infection? I'm sure they requested a follow up scan in 6 months to keep an eye on the nodules- that's usually helpful. Also, maybe the breathlessness can be a side effect of silent heartburn/acid reflux/gerd… Bronchoscopy is last resort I would think or hope, but that's just my opinion. Second opinions are always a good idea!

Jump to this post

Hi, thanks for your reply. They haven’t tested their mucus as they haven’t been coughing at all. As I understand, the only way to get samples of any fluids from the lungs for a pathologist to review would be through a bronchoscopy with biopsy and lavage.

Hopefully the patient can avoid having to get one but is willing to do so if necessary. Most recently the symptoms digressed (to include very slight pain in the chest for just an hour each day the last 2 days – hard for them to explain). The patient is definitely not going to sit idly by without getting some kind of action plan of recovery ASAP.

They haven’t had issues with acid reflux so that is out of the question. Again, the cause of the symptoms was accidental inhalation of food and/or liquid in mid December.

On to a 2nd opinion appointment on February 17th…

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@zoelife Got it, one thing my pulmonologist has said to me that has stained my brain is– (I'm at high risk for aspirating)– if you aspirate you don't want bacterial pneumonia to set in. So I guess it's surprising they only treated your friend with a steriod and not a antibiotic. Hope all goes well on the 17th!

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@fracturedd

@zoelife Got it, one thing my pulmonologist has said to me that has stained my brain is– (I'm at high risk for aspirating)– if you aspirate you don't want bacterial pneumonia to set in. So I guess it's surprising they only treated your friend with a steriod and not a antibiotic. Hope all goes well on the 17th!

Jump to this post

Sorry about what your Pulmomologost told you about being prone to aspirate. Recently I read somewhere about how tipping one’s head slightly downward can help to prevent food or liquid to go down the wrong path. One of my sisters who is a Doctor told me that a good percentage of people have been known to aspirate with no ill side effects because their immune system was strong. So on a positive note, if you don’t have any underlining severe illnesses or a suppressed immune system your body is in a good state to fight off any foreign invaders that would try to attack your immune system.

As to what you said with antibiotics, they can actually be more harmful than helpful if prescribed unnecessarily. There have been known to be many different side effects from aspiration – some people pneumonia (bacterial, viral, or foreign debris), some pneumonitis or hypersensitivity pneumonitis, some ILD (interstitial lung disease), some RI ILD (respiratory infection interstitial lung disease), some bronchiectasis, some bronchiolitis (of which there are constructive, obliteramos, fibrotic, or cellular versions), etc.

Even if the aspiration side effect caused a bacteria infection, I understand the most effective way to completely eradicate it is to get a biopsy and have it cultured by a pathologist in order to get an accurate idea as to the exact type of bacteria that caused it. This way the right type of antibiotic can be prescribed to eradicate it.

To blindly be prescribed antibiotics by a Doctor without them knowing the exact diagnosis can do more harm than good because many cases it may not be bacterial. Taking antibiotics unnecessarily could cause the person to build a resistance to the antibiotics which could be detrimental for them in a future situation where their body may need to rely on an infusion of antibiotics via IV to survive (in the case of sepsis, for example).

Thanks for your kind words as to the upcoming visit on the 17th. That will be conducted via video for the patient to get a second opinion. Their hope is the Doctor can make a diagnosis simply by viewing the CT chest scan rather than calling for a bronchoscopy. However, if a bronchoscopy is needed after all they will proceed that route.

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@zoelife Don't be sorry, just my doctors way to make me get on board with taking medication for gerd, lol. All meds have a risk vs. benefit factor.

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