Abstract
Cicatricial organizing pneumonia is an uncommon form of organizing pneumonia, which may manifest as persisting linear opacities on computerized tomography (CT) scan mimicking a fibrosing interstitial pneumonia. It may also manifest with pulmonary ossification, which is a metaplastic bone formation within the lung tissue. The latter presentation could be either nodular or dendriform, both secondary to underlying lung disease and rarely idiopathic. Dendriform pulmonary ossification (DPO) has rarely been described as a cause of spontaneous pneumothorax. We present a case of a 55-year-old male with history of recurrent pneumothoraces and worsening dyspnea on exertion. A CT of the chest revealed progressive bilateral sub-pleural and peribronchovascular reticular opacities associated with densely ossified branching and nodular opacities. Video-assisted thoracoscopic biopsy of the lung demonstrated cicatricial organizing pneumonia with areas of marked diffuse DPO. The case highlights that dendriform pulmonary ossification arising from cicatricial organizing pneumonia should be considered in the differential diagnosis of recurrent pneumonias among patients with lower lobe sub-pleural reticular opacities. The case highlights that dendriform pulmonary ossification rarely can cause spontaneous pneumothorax and can be associated with cicatricial organizing pneumonia and reticular opacities on imaging.
Highlights
Organizing pneumonia (OP) is characterized by the presence of organizing bromyxoid proliferations within the lumens of respiratory bronchioles and alveolar ducts
Peripheral and /or peribronchiolar consolidations are the most frequent ndings of OP on a computerized tomography (CT) scan. ese opacities could be migratory in nature
Cicatricial OP (OPc) is a newly described entity in the pathology literature [3, 4] and distinguished from conventional OP by formation of irreversible dense brous bands and small nodules in the background of conventional OP [4]. e reported CT ndings of OPc are variable and range from typical imaging ndings of OP to lower lobes predominant peribronchovascular and subpleural reticular opacities with or without pulmonary ossi cation [4]. e latter is characterized by metaplastic ossi cation in the lung and is classi ed into nodular (NPO) and dendriform (DPO) subtypes [5]
Summary
Organizing pneumonia (OP) is characterized by the presence of organizing bromyxoid proliferations within the lumens of respiratory bronchioles and alveolar ducts. E reported CT ndings of OPc are variable and range from typical imaging ndings of OP to lower lobes predominant peribronchovascular and subpleural reticular opacities with or without pulmonary ossi cation [4]. E latter is characterized by metaplastic ossi cation in the lung and is classi ed into nodular (NPO) and dendriform (DPO) subtypes [5]. Dendriform pulmonary ossi cation is usually described in association with chronic lung disease including usual interstitial pneumonia (UIP) [5, 6] it can be seen in isolation [7, 8]. Dendriform pulmonary ossi cation presenting with spontaneous pneumothorax has been reported in a few occasions [9,10,11,12,13,14] but rarely with OPc [4]. We report a case of cicatricial organizing pneumonia with DPO who presented with recurrent pneumothorax. e clinical, radiological and pathological ndings as well as the pulmonary functions have been described
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