Learning Radiology xray montage

Reactive Airways Disease

General Considerations

  • General term for a disease usually in the pediatric population featuring wheezing, shortness of breath and coughing
  • Initial episodes are frequently referred to as bronchiolitis
  • Unlike asthma, which is chronic, reactive airways disease is usually transient although it can progress over time to asthma
  • May be triggered by
    • Viral URIs, especially from respiratory syncytial virus (RSV)
    • Pollen and mold
    • Cigarette smoke
    • Extreme cold
  • Most (60%) of children who have wheezing before age 3 will outgrow it by age 6
  • Use of the term is controversial, some believing it is too general

Clinical Findings

  • Increased respiratory rate
  • Retractions
  • Cough
  • Fever
  • Rhinorrhea

Imaging Findings

  • Peribronchial thickening
    • Primarily lobar or segmental bronchi
    • While adults may have bronchi on end visible in the hila, children usually do not
    • Peribronchial thickening also produces tram-track like linear densities in the lung from bronchi visualize in profile
  • Hyperinflation
  • Atelectasis from mucus plugging

Differential Diagnosis

  • It is usually impossible to distinguish between viral bronchiolitis and asthma in a young child and the two may coexist
  • Reactive airways dysfunction syndrome (RADS) and irritant-induced asthma (IrIA)
    • Closely related forms of asthma that result from the nonimmunologicprovocation of prolonged bronchial hyperresponsiveness and airflow obstruction by inhaled irritants
  • Anaphylactic reaction
  • Foreign body aspiration


  • Bronchodilator
  • Steroids
  • Oxygen

Reactive Airways Disease. (Top) Peribronchial thickening (white circles) seen en face shows small donut-like rings in periphery of lungs, not normally seen. Contained in yellow circle are thickened bronchial walls seen in profile with a "tram-track appearance. (Bottom) Close-up of left lower lung in same patient shows more donut shaped thickened bronchial walls. (yellow arrows)
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Imaging in Pediatric Pulmonology, edited by RH Cleveland