Perfusion Patterns of Peripheral Organizing Pneumonia (POP) Using Contrast-Enhanced Ultrasound (CEUS) and Their Correlation with Immunohistochemically Detected Vascularization Patterns.

Ehsan Safai Zadeh,Amjad Alhyari,Charlotte Gabriele Luise Mohr,Christian Görg,Corinna Ulrike Keber,Christoph Frank Dietrich,Christina Carolin Westhoff,Corinna Trenker

doi:10.3390/diagnostics11091601

Abstract

Purpose: To describe the perfusion patterns of peripheral organizing pneumonia (POP) by contrast-enhanced ultrasound (CEUS) and their correlation with vascularization patterns (VPs) represented by immunohistochemical CD34 endothelial staining. Methods: From October 2006 until December 2020, 38 consecutive patients with histologically confirmed POPs were standardized-examined by CEUS. The time to enhancement (TE; classified as an early pulmonary-arterial [PA] pattern of enhancement vs. delayed bronchial-arterial [BA] pattern of enhancement), the extent of enhancement (EE; classified as marked or reduced), the homogeneity of enhancement (HE; classified as homogeneous or inhomogeneous), and the decrease of enhancement (DE; classified as rapid washout [<120s] or late washout [≥120s]) were evaluated retrospectively. Furthermore, tissue samples from the study patients were immunohistochemically stained with CD34 antibody. The presence of avascular areas (AAs) and the VPs were evaluated in all tissue samples. Results: The majority of POPs showed a BA pattern of enhancement (71.1%), an isoechoic marked enhancement (76.3%), and an inhomogeneous enhancement (81.6%). A rapid DE was observed in 50.0% of cases. On CD34 staining, all POPs had a chaotic VP, indicating BA neoangiogenesis. AAs (abscess, necrosis, hemorrhage) were identified in (41.9%) cases with an inhomogeneous enhancement on CEUS. Conclusion: On CEUS, POPs predominantly revealed a marked inhomogeneous BA pattern of enhancement with a rapid washout in 50% of cases. Furthermore, we demonstrated that the presence of a PA pattern of enhancement, found in 28.9% of POPs, did not exclude a BA neoangiogenesis as an important feature of chronic inflammatory and malignant processes.

Highlights

Lange described for the first time the clinical and pathological features of organizing pneumonia (OP) on the basis of postmortem histological findings in two patients with cough, fever and dyspnea who died in hospital [1]
If the underlying cause is not found in the follow-up, the disease is clinically termed as cryptogenic OP
We found that peripheral organizing pneumonia (POP) show a nonspecific pattern on contrast-enhanced ultrasound (CEUS)

Summary

Introduction

Lange described for the first time the clinical and pathological features of organizing pneumonia (OP) on the basis of postmortem histological findings in two patients with cough, fever and dyspnea who died in hospital [1]. He termed the disease “bronchitis et bronchiditis obliterans” [1,2]. A study from Iceland reported an incidence of 1.10/100,000 population for cryptogenic OPs and 0.87/100,000 for secondary forms of OP [4]. B-mode lung ultrasound (LUS) is considered to be a noninvasive complementary diagnostic method in addition to CT and PET-CT for the assessment of peripheral-based pulmonary lesions [7]

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