Cryptogenic organizing pneumonia (COP) and graft vs host disease (GvHD)
Presentation
Previous bone marrow transplant (BMT) for acute lymphoblastic leukemia (ALL)
Patient Data
There are bilateral patchy airspace opacities with some interstitial lines also noted in both lung bases. Costophrenic angles are clear. The heart is not enlarged. The hilar shadows are full and lymphadenopathy cannot be excluded. The features are most likely due to infection or possibly allergic response.
There is a predominant peribronchial and subpleural distribution of focal opacities some of which demonstrate surrounding ground glass. There is an apico-basal gradient with the mid and lower zones more significantly affected. There is relative sparing of the central parahilar regions of the lungs. No evidence of 'Air Crescent' sign demonstrated. Nodular opacities at the apices. No pleural effusion identified. Mild pleural thickening. No evidence of bronchiectasis. No evidence of mosaic attenuation. No thoracic lymphadenopathy is identified. No sinister bone lesion identified. The imaged solid organs of the upper abdomen are unremarkable.
Conclusion: The radiological appearances are consistent with cryptogenic organizing pneumonia and graft versus host disease as the most likely etiologies.
Case Discussion
Cryptogenic organizing pneumonia (COP) with evidence of graft versus host disease (GvHD)
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