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Bronchiolitis obliterans — RACP Paediatrics MCQ

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HardRespiratoryBronchiolitis obliteransRACP Paediatrics

A previously healthy 8-year-old has persistent dyspnoea and fixed airflow obstruction four months after severe adenovirus pneumonia requiring ventilation. Expiratory CT shows geographic mosaic attenuation and marked air trapping, without central bronchiectasis. Which diagnosis best integrates the findings?

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Correct answer: B — Post-infectious bronchiolitis obliterans causing small-airway obstruction

Explanation lettering: C = shown as A · A = shown as B · D = shown as C · E = shown as D · B = shown as E

A is correct. Severe adenovirus infection followed by persistent, non-reversible obstruction and expiratory mosaic air trapping is classic post-infectious bronchiolitis obliterans. B usually requires asthma/CF, sensitisation and central bronchiectasis. C should show important variability or reversibility. D is usually focal or unilateral. E causes restriction and diffuse interstitial change rather than an obliterative small-airway pattern.

Reference: RCH Melbourne, Cough: https://www.rch.org.au/clinicalguide/guideline_index/Cough/; Yu, Postinfectious bronchiolitis obliterans in children: https://pmc.ncbi.nlm.nih.gov/articles/PMC4705325/