Cryptogenic Organizing Pneumonia: Evolution of Morphological Patterns Assessed by HRCT.

Francesco Tiralongo,Pietro Valerio Foti,Antonio Basile,Agata Ferlito,Carlo Vancheri,Giulia Fazio,Giulio Distefano,Gianluca Sambataro,Monica Palermo,Sebastiano Emanuele Torrisi,Ada Vancheri,Federica Galioto,Stefano Palmucci,Letizia Antonella Mauro

doi:10.3390/diagnostics10050262

Abstract

To evaluate the radiological findings in patients with cryptogenic organizing pneumonia (COP) before steroid treatment and their behavior after therapy, we retrospectively evaluated a total of 22 patients with a diagnosis of COP made by bronchoalveolar lavage (BAL), biopsy or clinical/radiological features, and the patients were followed between 2014 and 2018 at the hospital; the demographic data, symptoms, radiologic findings, diagnostic methods and treatment plans of patients were collected from patients’ hospital records. At least two CT scans of 22 patients (16 female and six men) were evaluated, the first one before starting steroid therapy and the others after therapy. At baseline CT scans, the most common radiological finding was the presence of consolidations (18/22 patients, 81.8%); ground-glass opacities were also very common (15/25, 68.1%). The other findings were as follows: nodules and masses (5/22, 22.7%), atoll sign (4/22, 18.1%), perilobular pattern (3/22, 13.6%) and parenchymal bands (3/22, 13.6%). Two patients had a significant relapse after reducing/interrupting therapy, while three had a complete resolution and are not currently under therapy (maintenance of clinical remission with no oral corticosteroid (OCS)). In High-resolution computed tomography (HRCT) scans after therapy, consolidations were still observable in seven patients (five in new areas of the lung-migratory infiltrates), while most of them disappeared, leaving a residual area of ground glass opacity in two patients. One patient had a residual of the perilobular pattern, with the disappearing of the other findings (consolidations and ground-glass opacities). Two patients developed a fibrosing pattern despite the therapy (9.5%). Cryptogenic organizing pneumonia tends to respond to oral corticosteroid treatment, but some patients may have a null or partial response. We highlight the behavior of this disease after proper therapy.

Highlights

Organizing Pneumonia (OP) is a clinical, radiological and histological pattern characterized by the presence of granulation tissue within the terminal or respiratory bronchioles, in the alveolar ducts and surrounding alveoli, associated with chronic inflammation of the remaining lung parenchyma [1]
Since not all patients performed the first imaging tests in our Radiology Institute, we only considered chest CT scans that were compatible with High-resolution computed tomography (HRCT) standard protocol [37]
Based on the eligibility and exclusion criteria, we retrospectively enrolled a total of twenty-two patients with a diagnosis of cryptogenic organizing pneumonia (COP)

Summary

Introduction

Organizing Pneumonia (OP) is a clinical, radiological and histological pattern characterized by the presence of granulation tissue within the terminal or respiratory bronchioles, in the alveolar ducts and surrounding alveoli, associated with chronic inflammation of the remaining lung parenchyma [1]. OP accounts for 1.8% up to 13% of all Interstitial Lung Diseases (ILDs) [13,14,15]; the mean age at onset varies from 50 to 60 years and males and females are usually affected. The idiopathic form of OP has been called Cryptogenic Organizing Pneumonia (COP), and it has been classified as an acute/subacute Interstitial Lung Disease in the American Thoracic Society/European.

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