This process is in contrast to the histopathologic changes seen in usual interstitial pneumonia where extensive fibrosis and inflammation occur leading to fibroblastic foci to form in the alveolar spaces resulting in obliteration of the alveolar space, scarring and significant damage to lung architecture (the alveoli).Tissue inhibitors of metalloproteinases (which inhibit breakdown of the extracellular matrix connective tissue) are more active in usual interstitial pneumonia as compared to organizing pneumonia, this is thought to lead to a greater deposition of connective tissue in the alveolar space in interstitial pneumonia as compared to organizing pneumonia and may explain the progressive, irreversible fibrosis seen in usual interstitial pneumonia. Gelatinolytic activity (resulting in the breakdown of extracellular matrix connective tissue) is greater in organizing pneumonia as compared to usual interstitial pneumonia, and this is thought to contribute to the reversible fibroproliferation characteristic of organizing pneumonia. Diagnosis
On clinical examination, crackles are common, and more rarely, patients may have clubbing (<5% of cases). Laboratory findings are nonspecific but inflammatory markers such as the erythrocyte sedimentation rate or C-reactive protein and the lymphocyte count are frequently elevated.
This injury to the epithelial basal lamina results in inflammatory cells and plasma proteins leaking into the alveolar space and forming fibrin, resulting in an initial fibroblast driven intra-alveolar fibroproliferation. The fibroblasts differentiate into myofibroblasts and continue to form fibrosis resulting in intra-alveolar fibroinflammatory buds (Massons Bodies) that are characteristic of organizing pneumonia. These Massons bodies consist of inflammatory cells contained in an extracellular matrix consisting of type I collagen, fibronectin, procollagen type III, tenascin C and proteoglycans. Angiogenesis , or the formation of blood vessels, occurs in the Massons bodies and this is driven by vascular endothelial growth factor. Remodeling occurs, resulting in the intra-alveolar fibroinflammatory buds (Massons Bodies) moving into the interstitial space and forming collagen globules that are then covered by type 1 alveolar epithelial cells with well developed basement membranes. These type 1 alveolar epithelial cells (pneumocytes) then proliferate, restoring the continuity and function of the alveolar unit.