대한흉부영상의학회 Weekly Chest Cases

Courtesy of Ki Nam Kim, Ki-Nam Lee / Dong-A University Hospital, Korea
Age/Sex 33 / F
Chief ComplaintDyspnea for 4 months and coughing for one week after normal delivery

Diagnosis: Bronchiolitis Obliterans Organizing Pneumonia (Cryptogenic Organizing Pneumonia)
Radiologic Findings: Chest radiograph shows multifocal patchy areas of consolidations in both lungs. HRCT scan show a predominantly peribronchial and subpleural distribution of the consolidation. Air-bronchograms, focal areas of ground-glass attenuation, and a few centrilobular nodules are also evident.

TBLB was failed due to dyspnea, and open lung biopsy of left upper lobe revealed multiple granulation polyps filling respiratory bronchioles and alveolar ducts and bronchial wall thickening, consistent with bronchiolitis obliterans organizing pneumonia.

The patients deteriorated despite ventilator care, increase dose of steroid, and intravenous cyclophosphamide pulse therapy.
Brief Review: In many patients, the clinical and radiographic signs of disease remit completely after systemic corticosteroid therapy. However, a minority have disease that pursue a rapid course and has a worse prognosis; although some of these patients are still found to have idiopathic disease after careful investigation, such rapid progression in more likely to be associated with an underlying condition such as connective tissue disease or drug therapy. Patients with focal COP usually have no relapse or respiratory-related deaths.
References: Please refer to case 63, case 110, case 230, and case 294.
Keywords: Lung, Idiopathic interstitial pneumonia, COP, IIP,

대한흉부영상의학회 Korean Society of Thoracic Radiology