대한흉부영상의학회 Weekly Chest Cases

Case No : 294 Date 2003-06-14

Courtesy of Myung Hee Chung, M.D. / Holy Family Hospital, Catholic University, Pucheon, Korea
Age/Sex 42 / F
Chief ComplaintDyspnea for 3 months, exertional inspiration

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Diagnosis With Brief Discussion

Diagnosis: Bronchiolitis obliterans with organizing pneumonia
Radiologic Findings: Radiologic findings: Chest radiograph shows bilateral patchy ground glass opacities and large reticulations. HR CT scans show diffuse ground glass opacities with mild bronchovascular bundle distorsion and interlobular septal thickenings. Consolidations are predominant in basal lung fields. Pathologic findings show multiple areas of chronic inflammation with fibrosis and fibroblastic proliferation, and aggregation of alveolar macrophages in the alveolar spaces.
Brief Review: True incidence and prevalence of cryptogenic organizing pneumonia are unknown. Disease onset is usually in the fifth or sixth decade, with a mean age of 58 years. Duration is typically less than 2 months. Clinical presentation often mimics that of community-acquired pneumonia (usu. persistent and nonproductive cough, exertional dyspnea, low grade fever, weight loss). Major radiologic findings are pathcy bilateral airspace consolidation (80%), ground-glass opacity (60%), subpleural and/or peribronchovascular distribution. Minor findings are bronchial wall thickening, dilatation, small nodular opacities, large nodules, and pleural effusion. The histopathologic lesion is an excessive proliferation of granulation tissue within small airways and alveolar ducts, along with chronic inflammation in surrounding alveoli. Recovery is dramatic within a few days or weeks by corticosteroid. A cytotoxic agent should be considered if the patient deteriorates despite steroid.
References: 1. Schwarz MI, King Jr. TE. Interstitial Lung Disease 3rd ed. Hamilton: BC Decker Inc. 1998: 658-666
2. Lee KS, Kullnig P, Hartman TE, Muller NL. Cryptogenic organizing pneumonia: CT findings in 43 patients. AJR 1994; 162:543-546
Keywords: Lung, Idiopathic interstitial pneumonia, COP, IIP,

No. of Applicants : 24

▶ Correct Answer : 5/24, 20.8%

- Chungju Hospital Konkuk University, Korea Chang Hee Lee
- CIM Saint Dizier, France JC Leclerc
- Hangang Sacred Heart Hospital, Korea Eil Seong Lee
- Incheon Sarang Hospital, Korea Jung Hee Kim
- Jecheon Public Health Center, Korea Seung Hun Ryu

▶ Semi-Correct Answer : 9/24, 37.5%

- Annecy Hospital, France Gilles Genin
- CHU Nancy-Brabois, France Denis Regent
- Chung Li Ten-Chen Hospital,Taiwan Gui-Lin Zheng
- Dong-A University Hospital, Busan, Korea Ki-Nam Lee
- Kangbuk Samsung Hospital, Korea Semin Chong
- Ospedale di Jesi, Italy Giancarlo Passarini
- Social Security Hospital, Ankara, Turkey Meric Tuzun
- Tokyo Kouseinenkin Hospital , Japan Noriatsu Ichiba
- Upasana Hospital, Kollam, India Joy A Thomas

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 294 Date 2003-06-14

Discussion

No. of Applicants : 24