Cryptogenic organising pneumonia

Case contributed by RMH Report Writing

Presentation

Increasing shortness of breath over 7 weeks. Some fevers and dry non-productive cough. Inflammatory markers are normal.

Patient Data

Age: 78-year-old
Gender: Female

Chest radiograph

Modality: X-ray

Extensive bilateral mid and lower zone consolidation is noted.

The heart size is borderline.

CT Chest

Modality: CT

5 mm axial and coronal soft tissue and lung windows are available for review. No prior examination is currently available for correlation. This examination has been reported remotely.There are widespread peribronchial dense infiltrates involving all lobes. The changes are confluent around the bronchi, and more irregular further in the lung parenchyma. They are more extensive in the middle and lower zones with relative sparing of the apices. No cavitating lesions. No large pleural collection. No other pulmonary nodules.There are lymph nodes measuring up to 6mm in short axis in the central mediastinum, likely reactive. No large volume nodes.Visible parts of the solid organs of the abdomen appear satisfactory for this phase of contrast administration.No obvious central pulmonary arterial filling defects.No destructive bony lesions.

CONCLUSION: Bilateral lung infiltrates, aetiology uncertain on this examination. Infection (including atypical agents) would merit consideration, but an unusual pattern of pulmonary haemorrhage, inflammatory processes, or even an unusual vasculitis might merit consideration. Correlation should be made with clinical factors. Respiratory review is suggested.There are no specific features to suggest a granulomatous infection although the presence of this cannot be excluded on this examination.

Case Discussion

There was no clinical improvement following  treatment for cardiac failure. The radiological findings persisted after four weeks of antibiotic cover.

The patient was commenced on high dose steroids, leading to a clinical improvement and eventual improvement in imaging findings.

The presumptive diagnosis was of COP.

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Case Information

rID: 38634
Case created: 27th Jul 2015
Last edited: 12th Nov 2016
System: Chest
Tag: rmh
Inclusion in quiz mode: Included

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