Algorithmic Approach to the Diagnosis of Organizing Pneumonia

Cherian, Sujith; Patel, Dhara; Machnicki, Stephen; Naidich, David P.; Stover, Diane E.; Travis, William D.; Brown, Kevin K.; Naidich, Jason J.; Mahajan, Akhilesh; Esposito, Michael; Mina, Bushra; Lakticova, Viera; Cohen, Stuart L.; Müller, Néstor L.; Schulner, Jenna; Shah, Rakesh; Raoof, Suhail

doi:10.1016/j.chest.2021.12.659

Cited by 24 publications

(20 citation statements)

References 61 publications

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“…Areas of ground-glass attenuation or fine centrilobular nodules can be observed in association with the consolidation areas. Less frequently, solitary or multiple nodules mimicking a malignancy can be detected [ 1 , 4 , 22 ]. The NSIP pattern can sometimes overlap with the OP pattern [ 4 , 7 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…Less frequently, solitary or multiple nodules mimicking a malignancy can be detected [ 1 , 4 , 22 ]. The NSIP pattern can sometimes overlap with the OP pattern [ 4 , 7 , 15 ]. Histological analyses can reveal intraluminal polypoid plugs of loose connective tissue in the alveoli and bronchioles; the architecture of the lung is conserved and honeycombing is absent.…”

Section: Discussionmentioning

confidence: 99%

“…A biopsy may be unnecessary if the clinical and radiological features are highly suggestive of OP, but a histological confirmation is certainly useful to rule out other potential diagnoses such as a malignancy. A multidisciplinary discussion involving pulmonologist, radiologist, rheumatologist and histopathologist experts in ILD may be helpful in the diagnostic framework and work-up [ 1 , 4 , 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…The diagnostic performance of a TBLB in peripheral pulmonary lesions is highly variable and dependent on the lesion size and on the presence of a “bronchus sign” [ 28 , 29 , 30 , 31 ]; nevertheless, it can be considered to be the initial diagnostic procedure in most scenarios. Even if samples obtained are small biopsy specimens and the diagnostic adequacy of a TBLB remains debated, in the presence of a typical clinical and radiological picture, a histological pattern compatible with OP is sufficient to make the diagnosis [ 4 , 5 , 32 ]. During bronchoscopy, BAL can be performed; in patients with OP, it usually shows a mixed cellularity pattern with an increment in lymphocytes, neutrophils and eosinophils.…”

Section: Discussionmentioning

confidence: 99%

“…Organizing pneumonia should be suspected based on the clinical and radiological presentations, but it generally requires a histopathological confirmation to exclude other possible etiologies including malignancies [ 4 ]. Various biopsy techniques have been used in order to diagnose this pathology, but endoscopic techniques such as transbronchial lung biopsies and transbronchial lung cryobiopsies have shown a high diagnostic yield [ 4 , 5 ]. The treatment usually consists of a prolonged corticosteroid therapy and disease relapses are common [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

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Diagnosis of Organizing Pneumonia with an Ultrathin Bronchoscope and Cone-Beam CT: A Case Report

et al. 2022

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Organizing pneumonia (OP) is a pulmonary disease histopathologically characterized by plugs of loose connective tissue in distal airways. The clinical and radiological presentations are not specific and they usually require a biopsy confirmation. This paper presents the case of a patient with a pulmonary opacity sampled with a combined technique of ultrathin bronchoscopy and cone-beam CT. A 64-year-old female, a former smoker, was admitted to the hospital of Reggio Emilia (Italy) for exertional dyspnea and a dry cough without a fever. The history of the patient included primary Sjögren Syndrome interstitial lung disease (pSS-ILD) characterized by a non-specific interstitial pneumonia (NSIP) radiological pattern; this condition was successfully treated up to 18 months before the new admission. The CT scan showed the appearance of a right lower lobe pulmonary opacity of an uncertain origin that required a histological exam for the diagnosis. The lung lesion was difficult to reach with traditional bronchoscopy and a percutaneous approach was excluded. Thus, cone-beam CT, augmented fluoroscopy and ultrathin bronchoscopy were chosen to collect a tissue sample. The histopathological exam was suggestive of OP, a condition occurring in 4–11% of primary Sjögren Syndrome cases. This case showed that, in the correct clinical and radiological context, even biopsies taken with small forceps can lead to a diagnosis of OP. Moreover, it underlined that the combination of multiple advanced technologies in the same procedure can help to reach difficult target lesions, providing proper samples for a histological diagnosis.

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