B30-11 Case Series of Constrictive Bronchiolitis in Veterans Deployed to Southwest Asia

Introduction Four years ago, we started a pulmonary clinic at the Birmingham VA Medical Center dedicated to the evaluation and management of deployment-related and military occupational lung disease. I present a case series of patients who were deployed to Southwest Asia (Gulf War and Post-9/11 Conflicts) who presented to clinic with chronic dyspnea and underwent video-assisted thoracic surgery (VATS) biopsy leading to a diagnosis of constrictive bronchiolitis (CB). Description of Cases: Case 1 38yo male deployed 15 months to Iraq in 2008-09. During his service he was exposed to burn pits. He was seen in clinic for symptoms of dyspnea with exertion and chronic productive cough. Pulmonary function testing (PFTs) showed moderate obstruction with air-trapping. CT chest showed bilateral upper lobe air trapping. Pathology from VATS biopsy showed CB. Case 2: 36yo male deployed 18 months to Afghanistan in 2008-09 and 2013-14. During his service he was exposed to burn pits. He was seen in clinic for symptoms of dyspnea with exertion. PFTs showed moderate obstruction, restriction, and impaired diffusion. CT chest showed emphysema. Pathology from VATS biopsy showed CB. Case 3: 43yo male deployed 27 months to Iraq and Afghanistan in 2004, 2007, and 2009. During his service he had close prolonged exposure to burn pits. He was seen in clinic for symptoms of dyspnea and chest pain with exertion. PFTs showed mixed obstruction and restriction and diffusion impairment. CT chest showed air-trapping. VATS biopsy showed CB and chronic adhesive pleuritis. Case 4: 55yo male deployed 8 months to Iraq and Kuwait in 1990-91 during the Gulf War. During his service he was exposed to burn pits, oil fires, depleted uranium and blast exposure. He presented to clinic with symptoms of dyspnea and chronic cough. PFTs show mild restriction and diffusion impairment. CT chest showed NSIP pattern. Auto-immune and connective tissue disease labs were negative. VATS biopsy showed CB. Case 5: 62yo male deployed 9 months to Iraq and Kuwait in 1990-91 during the Gulf War. During his service he was exposed to oil fires, burn pits, and nerve agents (sarin, cyclosarin). He presented to clinic with symptoms of dyspnea on exertion, chronic cough and hypoxia. PFTs showed restriction and diffusion impairment. CT chest showed scarring and traction bronchiectasis with bilateral air-trapping. VATS biopsy showed CB. Discussion These cases highlight the non-specific nature of symptoms and the heterogeneity of non-invasive testing which make diagnosing constrictive bronchiolitis challenging.