대한흉부영상의학회 Weekly Chest Cases

Case No : 1362 Date 2023-11-28

Courtesy of Kum Ju Chae, David Lynch / National Jewish Health
Age/Sex 39 / F
Chief Complaint

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
Figure 7

Diagnosis With Brief Discussion

Diagnosis: Cicatrical organizing pneumonia (Organizing pneumonia with diffuse pulmonary ossification)
Radiologic Findings: There are innumerable small partially calcified nodules throughout the lung parenchyma. The distribution of these nodules is diffuse in the craniocaudal plane, and shows peribronchovascular and periseptal predominance in the axial plane.
Brief Review: Organizing pneumonia (OP) is pathologically characterized by the presence of organizing fibromyxoid proliferations within the lumens of respiratory bronchioles and alveolar ducts. Cicatricial OP (CiOP) is a newly described entity in the pathology literature. It is distinguished from conventional OP by the formation of irreversible dense fibrous bands and small nodules in the background of conventional OP. metaplastic ossification in the lung can be seen in the lung and it is classified into nodular and dendriform subtypes. Reticular opacities on CT imaging are seen in CiOP cases where fibrous bands and nodules are the predominant features of pathology with minor conventional OP. The presence of branching high densities on CT is suggestive of dendriform pulmonary ossification. It is known that the dendriform ossification and GERD is associated. Local acidity and hypoxemia can cause pulmonary fibroblast to differentiate into osteoblast, and microscopic, chronic low-level acid aspiration could therefore be expected to cause DPO. This patient had a history of GERD, and a surgical lung biopsy revealed organizing pneumonia with metaplastic ossification.
CiOP component probably persists without a complete resolution given the collagen deposition that is likely irreversible, but clinical impact might not be significant if it is limited to small areas. Conversely, CiOP with extensive involvement in the lung might compromise lung function with a less favorable outcome.
References: 1. S. A. Yousem, “Cicatricial variant of cryptogenic organizing pneumonia,” Human Pathology, vol. 64, pp. 76–82, 2017.
2. Churg, J. L. Wright, and A. Bilawich, “Cicatricial organizing pneumonia mimicking a fibrosing interstitial pneumonia,” Histopathology, vol. 72, no. 5, pp. 846–854, 2018.
3. Bin Saeedan M, Farver C, Mehta AC, Yadav R. Cicatricial Organizing Pneumonia with Dendriform Pulmonary Ossification: An Unusual Cause for a Recurrent Pneumothorax. Case Rep Pulmonol. 2019 Dec 9;2019:2379145.
Keywords

No. of Applicants : 83

▶ Semi-Correct Answer : 25/83, 30.1%

- McGill University Health Center , Canada ALEXANDRE SEMIONOV
- Oita university , Japan AYUMI KAMEI
- Healthy Longevity Medical Center , Japan SHIN-ICHI CHO
- Vita Hospital , Brazil DIOGO LAGO PINHEIRO
- Other , Korea (South) SEONGSU KANG
- Oita University, Faculty of Medicine , Japan FUMITO OKADA
- Osaka University , Japan AKINORI HATA
- Yokkaichi municipal hospital , Japan HIKARI FUKUI
- , Japan YUKIKO USUI
- Kyoto University Hospital , Japan YASUHISA KURATA
- Osaka Metropolitan University Hospital , Japan SHU MATSUSHITA
- Dokkyo Medical University , Japan HIROAKI ARAKAWA
- Seoul National University Hospital , Korea (South) SUNGHO HONG
- , China MING LU
- Kyoto University , Japan SHO KOYASU
- Hyogo Prefectural Kobe Children , Japan SHUHEI NORIMOTO
- Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO
- Fukuoka university , Japan KEISUKE SATO
- Ichinomiya Nishi Hospital , Japan Takao Kiguchi
- , Japan YUMI MAEHARA
- Toyota Kosei Hospital , Japan YUKI HAYASHI
- Kyoto university , Japan AKIHIKO SAKATA
- the first affiliatited hospital of nanjing medical univercity , China HAI XU
- , Korea (South) JIN WOO YOON
- Jiangsu province hospital , China WANGJIAN ZHA

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 1362 Date 2023-11-28

Discussion

No. of Applicants : 83