Bronchiolitis obliterans and usual interstitial pneumonia. A comparative clinicopathologic study.

The clinical, radiographic, and pathologic features were studied in 24 cases of bronchiolitis obliterans and 16 cases of usual interstitial pneumonia, to define better their distinguishing characteristics. Bronchiolitis obliterans had a more acute onset often associated with fever, while the presentation of usual interstitial pneumonia was insidious with dyspnea and cough. The radiographs in usual interstitial pneumonia uniformly showed bilateral interstitial opacities, while they were more variable in bronchiolitis obliterans, with air space densities in 15 and interstitial opacities in nine. Prognosis was considerably better for bronchiolitis obliterans patients. Resolution of disease occurred in nearly half, while no patient with usual interstitial pneumonia recovered. Three individuals with bronchiolitis obliterans (12.5%) died of progressive disease, compared to 10 with usual interstitial pneumonia (62.5%). Pathologically, the lesion in bronchiolitis obliterans affected mainly air spaces in a peribronchiolar distribution, while the changes in usual interstitial pneumonia were mainly interstitial and randomly distributed. The fibrosis in bronchiolitis obliterans was composed of proliferating fibroblasts, compared to collagen deposition in usual interstitial pneumonia. These findings emphasize that bronchiolitis obliterans and usual interstitial pneumonia represent separate and distinct clinicopathologic entities.