대한흉부영상의학회 Weekly Chest Cases

Courtesy of Inyoung Youn, Semin Chong, Jae Seung Seo / Chung-Ang University College of Medicine, Seoul, South Korea.
Age/Sex 67 / M
Chief ComplaintDyspnea on exertion for 6 months, fever, chilling for 3 days

Fig 1

Diagnosis: COP (Cryptogenic organizing pneumonia)
Radiologic Findings: Chest radiograph (Figure 1) showed multifocal patchy increased opacities in the both lungs. Lung window setting of the chest CT (Figure 2-5) scan showed subpleural , segmental or peribronchovascular ground glass opacities in both lungs. There were also combined fibrosis and traction bronchiectasis and emphysemas in both lungs.
He underwent video-assisted thoracic surgery biopsy at areas of ground glass opacities in right superior segment of RLL and posterior segment of RUL. One week later, he complained of more worsening dyspnea with progression of the lesion on serial follow up chest radiographs. Follow up chest radiograph (Figure 6, answer) and chest CT scan ( Figure 7-10, answer) showed more progression of the ground glass opacities and more fibrosis / parenchymal distorsion in both upper lobes than prior study. Ten days later after the biopsy, pathologic results showed fibroblast plug in the bronchiole with extension to the alveolar ducts (Figure 11). On the results of the clinical, radiologic and pathologic findings, we diagnosed cryptogenic organizing pneumonia in this case. After steroid therapy, his symptoms and chest radiographic findings have improved.
Brief Review: Please refer to case 63, case 110, case 230, case 286, and case 294.
References
Keywords: Lung, Idiopathic interstitial pneumonia, IIP,

- Shinsegye Rad Clinic, Daegu , Korea (South) Gi Beom Kim
- Univ. of Miami/Jackson Memorial , United States mantosh rattan
- Vital Imaging Centre, Mumbai,India , India Ganesh Agrawal
- Samsung Medical Center , Korea (South) Eun Kim
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- PITTWATER RADIOLOGY , Australia Saurabh Khandelwal
- PITTWATER RADIOLOGY , Australia Julie Arora

대한흉부영상의학회 Korean Society of Thoracic Radiology