Purpose or Case Report: Pulmonary manifestations of inflammatory bowel disease (IBD) are well described in adults but appear less frequent and less systematically characterized in pediatrics. We aimed to describe the spectrum and prevalence of lung imaging findings in pediatric and young adult patients with IBD and to explore whether available pulmonary function tests (PFTs) contextualize imaging abnormalities
Methods & Materials: We conducted a retrospective review of consecutive patients with IBD who underwent chest imaging at a tertiary children’s hospital; demographic data, IBD subtype, and imaging findings were retrieved. Imaging modalities included clinically acquired CT obtained for routine care; no research imaging was performed. Variables captured included pulmonary nodule, subpleural nodule, small airway disease, bronchiectasis, interstitial lung disease, pleural effusion, lung scarring, pleural thickening, multifocal pneumonia. When available, PFT (FEV1, FVC, FEV1/FVC, TLC, DLCO; percent predicted) were recorded. Descriptive statistics summarized prevalence and central tendency.
Results: Thirty-seven patients met inclusion (26 male; age 8–22 years, mean 19.1). IBD subtype was ulcerative colitis in 15, Crohn disease in 9, and unspecified/not recorded in 13. Pulmonary nodules were present in 6/37 (16.2%); subpleural nodules in 4/37 (10.8%). Lung scarring occurred in 5/37 (13.5%); small airway disease in 3/37 (8.1%); pleural effusion, pleural thickening, and bronchiectasis were each uncommon (1/37, 2.7% for each). Interstitial lung disease and multifocal pneumonia were not observed (0/37). Co-occurrence of pulmonary nodules with scarring was rare (1 case). Ten patients (27.0%) had PFTs; mean percent predicted values were: FEV1 97.7, FVC 97.4, FEV1/FVC 90.7, TLC 99.3, DLCO 84.4, indicating largely preserved spirometry with a modestly reduced diffusing capacity in a subset. Pneumonias were uncommon and appeared incidental in relation to IBD activity
Conclusions: In this pediatric and young adult IBD cohort, pulmonary imaging abnormalities were dominated by incidental nodules and parenchymal scarring, while bronchiectasis, pleural disease, and small airway changes were infrequent and interstitial patterns were absent. Multifocal pneumonia was not a feature of the cohort, supporting the view that most pneumonias, when present, are incidental rather than IBD-related immune dysfunction. Where available, PFTs were largely within normal limits, suggesting limited functional impact of the observed imaging findings.