Cryptogenic organising pneumonia

Case contributed by RMH Report Writing

Presentation

Increasing shortness of breath over 9 weeks. Previous history of left upper lobe resection for adenocarcinoma.

Patient Data

Age: 72-year-old
Gender: Female

CT Chest

Modality: CT

There is extensive patchy bilateral consolidation.

Left posterior pleural collection (3.5 x 6.9 x 4.2 cm) is noted, with an enhancing pleural rim.

Anteriorly loculated pleural fluid is also seen anteromedial to the left upper zone, abutting the mediastinum.

Multiple enlarged mediastinal lymph nodes are unchanged from 16/09/2015.

Imaged upper abdominal organs are unremarkable.

No suspicious osseous lesion.

Conclusion:

Patchy bilateral consolidation, most likely infective in nature.

Rim-enhancing left pleural collection with loculated left upper zone pleural fluid suspicious for empyema in this clinical setting, although it is possible that the pleural enhancement and loculation could also be secondary to recent VATS. Further clarification with FNA recommended.

Case Discussion

The CT findings were considered most likely to be due to infection or pulmonary oedema. There was no history of prior radiotherapy. Treatments for both infection and oedema did not result in either a clinical improvement or changes on imaging.

Her presentation was considered most likely due to COP; there were no indicators to suggest a pulmonary eosinophilic condition. Her symptoms slowly improved with steroid administration. No histology was ever obtained. 

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Case Information

rID: 41597
Case created: 9th Dec 2015
Last edited: 13th Nov 2016
System: Chest
Tag: rmh
Inclusion in quiz mode: Included

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