Rare case of Cryptogenic organising pneumonia Abstract ID: 1222

Cryptogenic organising pneumonia Clinical background: 58 yrs old male patient present with cough and breathlessness – 2 months, not responding to antibiotics.

 Multiple irregular sub pleural and peribronchial consolidations with airbronchogram.  Interspersed areas of ground glass opacities  Involving apical and anterior segments of the Right upper lobe, superior and lateral basal segments of the Right lower lobe. HRCT findings of chest:

HRCT Findings  Few of these areas show crescentic opacities with ground glass opacities in the canter( Atoll sing).  Similar areas of opacities are also present at anterior segment of Left upper lobe, superior segment of the Left lower lobe.

Cryptogenic organising pneumonia

Diagnosis: Cryptogenic organising pneumonia / Bronchiolitis Obliterans Organizing Pneumonia.

Discussion Epidemiology and clinical presentation Presentation is commonest in the age group. Patients present with short history (i.e. less than 2 months) of breathlessness, non productive cough, weight loss, malaise and fever. There is no association with smoking.

Pathology In addition to the alveolar inflammatory changes found with a normal pneumonia, there is also involvement of the bronchioles. Histologically, it is characterized by the presence of buds of granulation tissue (Masson bodies) in the distal airspaces which may cause secondary bronchiolar occlusion due to extension of the inflammatory process. Hence, the reason for being previously termed bronchiolitis obliterans organizing pneumonia (BOOP )

HRCT The most common HRCT features include. Patchy consolidation with a predominantly subpleural and / or peribronchial distribution Small, ill-defined peribronchial or peribronchiolar nodules Large nodules or masses Bronchial wall thickening or dilatation in the abnormal lung regions A perilobular pattern with ill-defined linear opacities that are thicker than thethickened interlobular septa and have an arcade or polygonal appearance Ground glass opacity or crazy paving The reverse halo sign (atoll sign) is considered to be highly specific, although only seen in 20% of patients with COP.

Radiographic features Chest radiograph Consolidation – Bilateral patchy areas ( commonest finding ) : often migratory – Can affect all lung zones – Usually peripheral, sub-pleural, peribronchovascular Nodules – Foci of granulation tissue up to 1 cm – Simulate neoplasm if > 5 cm in size – May be numerous in immunocompromised patients

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