ОРГАНИЗУЮЩАЯСЯ ПНЕВМОНИЯ У ДЕТЕЙ: ЭПИДЕМИОЛОГИЯ, ЭТИОЛОГИЧЕСКАЯ СТРУКТУРА, КЛИНИЧЕСКАЯ И КОМПЬЮТЕРНО-ТОМОГРАФИЧЕСКАЯ СЕМИОТИКА, КОМОРБИДНОСТЬ И ТЕРАПИЯ

Abstract

Organizing pneumonia (OP) is an interstitial lung disease (ILD), which is characterized by the proliferation of granulation tissue in the bronchioles and alveoli, and diagnosed on the basis of clinical history, morphological data, CT changes and response to glucocorticoid (GC) therapy. Information about OP in children is limited due to the insufficient number of cases described and observed. The purpose of this research was to establish the epidemiological characteristics, etiological structure, clinical and CT semiotics of OP in children, to characterize its comorbidity and therapy. Materials and methods used: 20 children aged 4 months to 17 years old with OP were observed in 2009-2023. The diagnosis was set based on the clinical and anamnestic data, the presence of specific CT patterns, positive clinical and radiological dynamics during GC therapy, and (in 2 cases) according to histological examination results. Results: the ratio of boys to girls was 1.8:1, most often OP was diagnosed in infants (40%) and young children (30%) with various comorbid diseases with a frequency of 0.012‰ in the structure of all hospitalized patients of a multidisciplinary hospital in Moscow (Russia) in 2014-2022 The reasons for the acute (80%) and subacute (20%) OP were respiratory infections (40%), aspiration (30%), diffuse connective tissue diseases (DCTD) (10%), in a single case the OP had developed as part of lung injury associated with vaping and electronic cigarettes (EVALI), 15% of patients had an idiopathic version of OP (cryptogenic OP). The clinical picture of OP was characterized by shortness of breath (100%), cough (90%), fever, rales/crepitus (65%), wheezing (45%); the chest CT scan (n=19) showed zones of consolidation (100%), including subpleural localization (84%), trapezoidal shadowing (27%), zones of “ground glass” (68%), reversed halo sign (32%). Therapy included GC (95%), azithromycin (40%), mechanical ventilation (40%), oxygen therapy (60%). Clinical and radiological improvement occurred in 18 (90%) children, and death occurred in 2 (10%) children. Conclusion: OP is a rare variant of ILD whose reasons in children can be respiratory infections, aspiration, DCTD, EVALI. The effectiveness of GC in the presence of characteristic symptoms and CT images confirms the diagnosis.