Bronchiolitis obliterans following exposure to sulfur mustard: chest high resolution computed tomography

Eur J Radiol. 2004 Nov;52(2):164-9. doi: 10.1016/j.ejrad.2004.03.018.


Background: Pulmonary complications are known to occur in over half of the patients exposed to sulfur mustard (SM). Chemical weapons of mass destruction (WMD) including SM were used by Iraq during Iran-Iraq war between 1983 and 1989. We undertook this study to evaluate the chest high resolution computerized tomography (HRCT) as a diagnostic tool in patients with documented exposure to SM and chronic respiratory symptoms.

Method: The medical records of 155 patients exposed to SM during Iran-Iraq war and suffered respiratory complications were reviewed. Chest HRCTs of these patients were examined. Ten healthy controls with no history of exposure to HD were matched for age, gender, and chest HRCT protocol applied.

Results: Fifty chest HRCTs of these patients were randomly selected for this study. The most frequent findings were; air trapping 38 (76%), bronchiectasis 37 (74%), mosaic parenchymal attenuation (MPA) 36 (72%), irregular and dilated major airways 33 (66%) bronchial wall thickening (BWT) 45 (90%), and interlobular septal wall thickening (SWT) 13 (26%), respectively. Air trapping in one patient (10%) was the only positive finding in the control group.

Conclusions: Chest HRCT findings of bronchiectasis, air trapping, MPA, SWT, and BWT were seen in our patients 15 years after exposure to HD. These findings suggest the diagnosis of bronchiolitis obliterans (BO). We did not encounter chest HRCT features consistent with pulmonary fibrosis.

MeSH terms

  • Adolescent
  • Adult
  • Bronchiolitis Obliterans / chemically induced*
  • Bronchiolitis Obliterans / diagnostic imaging*
  • Case-Control Studies
  • Chemical Warfare Agents / adverse effects*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Mustard Gas / adverse effects*
  • Tomography, X-Ray Computed* / methods


  • Chemical Warfare Agents
  • Mustard Gas