Download Rare case of Cryptogenic organising pneumonia

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.
HRCT findings of chest:
 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
 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
Cryptogenic organising pneumonia
Diagnosis:
Cryptogenic organising pneumonia /
Bronchiolitis Obliterans Organizing
Pneumonia.
Discussion
Epidemiology and clinical presentation
• Presentation is commonest in the 55-60 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
Thank you.!