Bronchocentric granulomatosis

Last revised by Henry Knipe on 19 Oct 2022

Bronchocentric granulomatosis is a rare chronic condition where airway granulomas form in response to different insults. It is included in the spectrum of eosinophilic lung disease.

Bronchocentric granulomatosis can affect a wide age spectrum of patients but is thought to peak between the 4th to 7th decades 6.

Approximately one-third to half of the affected patients have tissue eosinophilia and tend to have a combination of asthma, peripheral eosinophilia, fungal hyphae at biopsy, and positive sputum cultures for Aspergillus organisms 9.

Other rare reported associations include:

Its underlying cause is often unclear. The current pathogenetic mechanism is considered to be an immunologic reaction against endobronchial antigens 3.

Microscopically, it is characterized by necrotizing granulomatous inflammation of bronchial and bronchiolar epithelium with chronic inflammatory changes in the surrounding lung parenchyma. It does not invade the pulmonary arteries (cf. necrotizing sarcoid granulomatosis, granulomatosis with polyangiitis (GPA), lymphomatoid granulomatosis9

CT features of bronchocentric granulomatosis are non-specific and can include a focal mass or lobar consolidation with atelectasis 9.

It is usually treated with short-term corticosteroids and tends to have a favorable overall prognosis 4. Some case may resolve spontaneously 6.

It is thought to have been initially described by Liebow et al. in 1973 6.

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