Presentation
Diagnosed with pneumonia 2 weeks ago. Increasing shortness of breath despite oral antibiotics.
Patient Data
Bilateral airspace opacity affecting both lungs, this has progressed markedly from previous chest x-ray (not shown).
Extensive but patchy airspace opacity throughout both lungs with few areas of air bronchograms, and some cavitation on the right. Further areas of groundglass opacity. Predominantly basal pattern. No particular nodularity identified. Small right pleural effusion. Trachea and proximal airways are unremarkable. Cardiomegaly. No suspicious bone lesion.
The patient was admitted but there was no clinical response to IV antibiotics. Bronchoscopy did not identify a cause with cultures and viral testing negative. He was treated with oral corticosteroids with improvement in symptoms and subsequent radiographic resolution.
Lungs and pleural spaces are clear with the previously demonstrated consolidation resolved. Normal cardiomediastinal contours.
Case Discussion
The clinical scenario of progressive peripheral airspace opacity without response to antibiotics is suspicious for cryptogenic organizing pneumonia, although in this case, it is most likely an organizing pneumonia secondary to infection.