Cryptogenic organizing pneumonia

Case contributed by Dr Mohammad A. ElBeialy


Cough, mild dyspnea, chest pain and low grade fever for 3 months.

Patient Data

Age: 25 years
Gender: Female

  • Multiple bilateral predominantly basal and peripheral subsegmental consolidations with air bronchograms are seen, smaller consolidations are seen within the mid lung zone as well as both upper lobes anterior segments. The opacification are predominantly bronchocentric.
  • Small patchy areas of ground glass attenuation as well as reticular pattern and subpleural nodules.
  • Mild bronchial dilatation with bronchial wall thickening is seen in the right upper lobe anterior segment as well as the right middle lobe medial segment.
  • No pleural effusion.
  • Small non-specific mediastinal lymph nodes.

Case Discussion

The above described findings with peripheral subpleural air-space consolidation and ground glass attenuation are highly suggestive of cryptogenic organizing pneumonia (COP) (a.k.a. bronchiolitis obliterans organizing pneumonia).

The DDX is:

  • chronic eosinophilic pneumonia, yet with predominantly upper lobe predilection.
  • sarcoidosis: alveolar sarcoid is around the bronchovascular bundles; not peripheral. It is usually upper lobe predominance with associated lymphadenopathy is common.        
  • multifocal broncho-pneumonia: Patients with BOOP are usually long treated for pneumonia!
  • lymphoma: not peripheral, centered on the bronchi with air bronchogram. Usually known lymphoma with enlarged hilar or mediastinal lymphadenopathy.
  • bronchioloalveolar cell carcinoma: not subpleural with ground glass nodules.
  • pulmonary thromboembolism:  peripheral subpleural consolidations identical to BOOP, yet pleural effusion and history of deep venous thrombosis (DVT) is usually discriminatory.
  • lipoid pneumonia: fat density with history of lipoid ingestion.  

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