Objective To improve the knowledge of cryptogenic organizing pneumonia ( COP) , and reduce misdiagnosis and mistreatment. Methods The medical records of 22 patients with biopsy-proven COP from January 2006 to October 2011 were retrospectively reviewed. The clinical presentation, laboratory data, radiographic results and treatment were collected and analyzed. Results The clinical presentations were nonspecific, and the most common symptomof COPwas cough ( 95. 45% ) . The laboratory data analysis revealed that elevated erythrocyte sedimentation rate in 71. 43% of the COP patients. The COP patients usually presented with a restrictive ventilation dysfunction and decreased diffuse function on pulmonary function test. The most common patterns of lung abnormality on chest CT scan were bilaterally multifocal patchy consolidation or ground-glass opacification ( 63. 64% ) , which distributed along the bronchovascular bundles or subpleural lungs. Patchy consolidation with air bronchograms was also a common feature ( 54. 55% ) . Migration over time and spontaneous remission of consolidation were important pointers.Histopathology by transbronchial lung biopsy was a valuable means for diagnosis. The majority of COP patients were non-response to antibiotics, but responded rapidly and completely to oral administration of corticosteroids with good prognosis. Conclusions The clinical presentations and laboratory data of COP patients are nonspecific. Initial imaging findings of COP are similar with pneumonia. Strengthening the recognition of COP is conducive to reducing misdiagnosis and reasonable antibiotics use.
Objective To highlight the characteristics of acute fibrinous and organizing pneumonia ( AFOP) . Methods The clinical, radiological and pathological data of two patients with AFOP were analyzed, and relevant literature was reviewed. Results Two male patients with the age of 48 years and 43 years presented with fever, cough, dyspnea and chest pain. The chest CT scan revealed multiple, bilateral, patchy consolidation distributing in peripheral areas in one case and consolidation in the middle lobe of the right lung and a little pleural effusion in another case. Two patients were diagnosed initially as community acquired pneumonia, but antibiotic treatment was ineffective. After the transbronchial lung biopsy and computed tomography guided percutaneous lung biopsy, pathological examination revealed there were numerous fibrin and organizing tissue in the alveoli without pulmonary hyaline membrane, which were consistent with AFOP. The patients showed significant clinical and radiological improvement after corticosteroid therapy. One patient was stable and the other one died of respiratory failure because of relapse during dose reduction of corticosteroids. Conclusions Patients of AFOP were misdiagnosed as pneumonia easily. Treatment with corticosteroids could be effective to some patients. If the antibiotic treatment was ineffective to the patient with fever and consolidation in the lungs, AFOP should be considered in the differential diagnosis.
Objective To analyze the clinical presentations and radiological characteristics of pathologically proved cases of cryptogenic organizing pneumonia(COP).Methods The clinical and radiological features of 8 patients with COP confirmed by open lung biopsy were analyzed.Treatment and follow-up data were also recorded.Results There were 5 male an 3 female patients aged 37 to 68 years.Dyspnea，cough and inspiratory crackles were the most common symptoms and signs.Various computed tomography findings including ground glass opacities,pathy consolidation with air bronchograms，nodules and reticulation were simultaneously observed in the same patient.The diagnostic imaging features of COP were patchy or lobar consolidation，often by a predominantly subpleural distribution，and irregular band-like opacities distributed along the bronchovascular bundle or located in the subpleural area.All patients were treated with corticosteroids and yielded significant improvement in seven cases.Conclusions COP could be diagnosed by clinical and radiological findings and histopathological examination was needed for confirmed diagnosis.In general，COP responds well to glucocorticoid therapy and has a benign prognosis.
ObjectiveTo explore the clinical, radiological and pathological characteristics of acute fibrinous and organizing pneumonia (AFOP). MethodsA case pathologically diagnosed with AFOP in September 2013 in the Second Affiliated Hospital of Nanjing Medical University was reported, and the related literature was reviewed. ResultsA 50-year-old woman with fever, chills, cough with sputum and chest pain was admitted to this hospital. The chest CT showed the nodules and patching infiltrates of the right middle lung. The pathological examination revealed the focally exudation of fibrin, lymphocyte infiltration and the presence of foam cells within the alveolar spaces, which is different from other well-known acute lung injures such as diffuse alveolar damage, cryptogenic organizing pneumonitis, and acute eosinophilic pneumonia. Coticosteroid therapy was induced and the patient showed significantly clinical and radiological improvement. ConclusionAFOP has no specific clinical, laboratory tests and radiology features, and it's diagnosis depends on pathological examination. Treatment with coticosteroids is proved to be effective.
ObjectiveTo retrospectively analyze the clinical,pathological and imaging features of one case pathologically diagnosed as cryptogenic organizing pneumonia(COP) to improve clinical diagnosis and treatment. MethodsWith a case report and review of the related literatures,the clinical manifestations,radiological features,pathological features,differential diagnosis,management and prognosis of COP were discussed. ResultsThe clinical manifestations of COP had no specificity. The imaging manifestations were real shadows,ground glass shadows,nodules and all kinds of tape. Pathological features of lung specimen biopsy showed buds of granulation tissue within alveolar ducts and alveoli consisting of fibroblasts. Remarkable response to corticosteroids was found in this patient. The prognosis of COP was good. ConclusionsCOP is diagnosed on basis of clinical,pathologic,and imaging findings. The radiological features of COP which show mass with cavity are rare. It can be easy misdiagnosed as lung infection or tumor. The effects of ordinary anti-bacteria therapy are limited,while the corticosteroids therapy shows preferable effects. Therefore,it's important to acquire pathological evidences as early as possible to guide the diagnose and treatment.
ObjectiveTo improve clinicians' awareness of cryptogenic organizing pneumonia (COP).MethodsThirty-three inpatients with COP, who had been diagnosed by pathology in Nanjing Drum Tower Hospital during January 2013 to December 2016 were collected. Their clinical manifestations, laboratory tests and imaging data were reviewed and analyzed retrospectively.ResultsThirty-three cases consisted of 18 males and 15 females, and the mean age was (58.7±13.5) years old. Most patients had subacute or insidious onset. The common symptoms were cough, fever, shortness of breath and chest tightness. About half of patients revealed inspiratory crackles or velcroes. Autoantibodies and anti-neutrophil cytoplasmic antibodies were negative. High-resolution computerized tomography findings of COP included bilateral patchy areas of air-space consolidation that showed predominantly subpleural or peri-bronchovascular distribution, focal nodules, enlarged hilar or mediastinal lymph nodes and pleural effusion. 25 patients were treated with glucocorticoid, 6 with macrolid, and 2 were only followed up without drug treatment.ConclusionsClinical manifestations, laboratory tests and imaging features are important clues to diagnose COP. Diagnosis depends on pathology. Meanwhile, definite pathogen and potential underlying diseases must be excluded.
ObjectiveTo analyze the clinical characteristics of patients with amyopathic dermatomyositis with organizing pneumonia (ADM-OP).MethodsThe clinical data of 8 patients hospitalized with ADM-OP from June 2014 to June 2018 were retrospectively reviewed and simultaneously compared with those of 8 patients of cryptogenic organizing pneumonia (COP).ResultsThe incidence of skin lesion, Gottron’s sign, mechanic’s hand and positive anti-synthase antibodies in the ADM-OP patients were 87.5%, 87.5% 75.0% and 87.5% respectively. Gender, smoking, respiratory symptoms and signs, arterial partial pressure of oxygen, arterial partial pressure of carbon dioxide and treatment strategy were no statistical difference between ADM-OP and COP patients, but the onset age and Chest CT fibrosis scores (CTFS) on admission existed differences. After treatment for 3 months, CTFS, rate of change and forced vital capacity (FVC) existed differences. After treatment for 6 months, CTFS, rate of change, FVC and diffusing capacity of the lung for carbon monoxide existed differences.ConclusionsSkin lesion, Gottron’s sign, mechanic’s hand and positive anti-synthase antibodies are more common in ADM-OP patients. Their response to treatment is good but the improvement rates in CTFS and pulmonary function are slower than those of COP patients.