Roentgenographic findings in bronchiolitis

Background. Acute bronchiolitis is a very frequent respiratory infection in infancy characterized by obstructive respiratory distress with crepitations and wheezing. The diagnosis of bronchiolitis is complex because characteristic radiological patterns are combined with each other. The aim of this study is to reveal radiologic changes in patients with acute bronchiolitis. Methods. One hundred and seventy-five children with bronchiolitis in their first wheezing episode were included in this study, who were admitted to the pediatric intensive care unit between 2000 and 2008. All patients underwent X-rays of the lungs in addition to other clinical and laboratory examinations. Results. Our results show that radiological changes were present in all cases: hyperinflation of the lungs in 175 children (100%), perihilar linear density and peribronchal thickening in 121 children (69.14%), bilateral bronchopneumonia in 44 children (25.14%), lobar pneumonia in 26 children (14.85%) and atelectasis in 28 children (16%). Usually radiological changes appear in combined forms: pulmonary hyperinflation and pulmonary trauma signs in 121 children (69.14%), pulmonary hyperinflation with bronchopneumonia and atelectasis in 31 children (17.71%), pulmonary hyperinflation with lobar pneumonia and atelectasis in 23 children (13.14%). Conclusions. We conclude that pulmonary hyperinflation and perihilar linear density are more evident when the auscultatory findings are poor. This fact has a practical value and is the main cause for the disappearance of alveolar consolidation. The differentiation between viral and bacterial bronchopneumonia as well as pneumonia and atelectasis is specially important. The radiological aspect gives us guidance for therapeutic follow up and treatment.