Computed tomography (CT) may be used to confirm the diagnosis. Often the findings are typical enough to allow the doctor to make a diagnosis without ordering additional tests. To confirm the diagnosis, a doctor may perform a lung biopsy using a bronchoscope. Many times, a larger specimen is needed and must be removed surgically. Plain chest radiography shows normal lung volumes, with characteristic patchy unilateral or bilateral consolidation. Small nodular opacities occur in up to 50% of patients and large nodules in 15%. On high resolution computed tomography, airspace consolidation with air bronchograms is present in more than 90% of patients, often with a lower zone predominance. A subpleural or peribronchiolar distribution is noted in up to 50% of patients. Ground glass appearance or hazy opacities associated with the consolidation are detected in most patients. Histologically, cryptogenic organizing pneumonia is characterized by the presence of polypoid plugs of loose organizing connective tissue (Masson bodies) within alveolar ducts, alveoli, and bronchioles. Unusual presentations of organizing pneumonia
While patchy bilateral disease is typical, there are unusual variants of organizing pneumonia where it may appear as multiple nodules or masses. One rare presentation, focal organizing pneumonia, may be indistinguishable from lung cancer based on imaging alone, requiring biopsy or surgical resection to make the diagnosis. Complications
Rare cases of COP have induced with lobar cicatricial atelectasis. Treatment
Systemic steroids are considered the first line treatment for organizing pneumonia, with patients often having clinical improvement within 72 hours of steroid initiation and most patients achieving recovery.
This presentation is usually so suggestive of an infection that the majority of patients with COP have been treated with at least one failed course of antibiotics by the time the true diagnosis is made. Symptoms are usually subacute, occurring over weeks to months with dry cough (seen in 71% of people), dyspnea (shortness of breath)(62%) and fever (44%) being the most common symptoms. Causes
Pulmonary infection by bacteria, viruses and parasites
Drugs: antineoplastic drugs, erlotinib, amiodarone
Chemical exposure, most notably to diacetylVaping: On October 17, 2019, the American Journal of Clinical Pathology reported that lung biopsies from patients with vaping-associated pulmonary illness show acute lung injury patterns, including organizing pneumonia. Ionizing radiations
Inflammatory diseases
Systemic lupus
Rheumatoid arthritis (RA-associated COP)
Scleroderma
Bronchial obstruction
Proximal bronchial squamous cell carcinoma
SARS-CoV-2
Analysis of COVID-19 CT imaging along with postmortem lung biopsies and autopsies suggest that the majority of patients with COVID-19 pulmonary involvement also have secondary organizing pneumonia (OP) or its histological variant, acute fibrinous and organizing pneumonia, which are both well-known complications of viral infections. It was identified in 1985, although its symptoms had been noted before but not recognised as a separate lung disease. The risk of COP is higher for people with inflammatory diseases like lupus, dermatomyositis, rheumatoid arthritis, and scleroderma. It most commonly presents in the 5th or 6th decade of life and it is exceedingly rare in children. Pathophysiology
Organizing pneumonia is usually preceded by some type of lung injury that causes a localized denudation or disruption in continuity of the epithelial basal laminae of the type 1 alveolar pneumocytes that line the alveoli.