Presentation
Dry cough, night sweats, fatigue, weight loss, anorexia for about thirty days. Non smoker.
Patient Data
Bilaterally in the lower lobes, in the middle lobe and the lingula are multifocal patchy parenchymal consolidations, with blurred margins associated with ground-glass opacity.
Resolution of inflammatory infiltrates in the lower lobes and improved appearance in the upper lobe and middle lobe lateral segment. Atoll sign more appreciable in the apical segment of the lower lobes. Ground glass areas in the lower lobes, and in the left upper lobe.
Bronchoscopy with bronchoalveolar lavage and transbronchial biopsies:
Strips of lung parenchyma with fibrin in intermingled cells to granulocytes and inflammatory interstitial aggregates. Various formations polypoid endobronchial connective tissue is present. Occasional alveolar histiocytes.
Case Discussion
Organizing pneumonia is classified as part of the idiopathic interstitial pneumonias and presents clinically with similar aspects to those of pneumonia. The inflammatory outbreaks may resolve spontaneously and then reform elsewhere, often more cranial, sometimes in the contralateral lung (migrating opacity).
Case courtesy: Prof Fabio Denicolò.