Posts: 3,675,934
Threads: 734,342
Joined:
Sep 2021
Reputation:
5
A 54-year-old woman is evaluated for recurrent pneumonias. Over the past 9 months she has had three episodes of shortness of breath, fatigue, and low-grade fever associated with alveolar opacities on chest radiograph. She has systemic hypertension and underwent surgery and radiation therapy for breast cancer 1 year ago. Current chest radiograph shows a patchy peripheral right-sided alveolar infiltrate. HRCT scan confirms alveolar consolidative opacity in the upper lobe. Bronchoscopy with transbronchial lung biopsy shows patchy organizing intraluminal exudates (organizing pneumonia).
Which of the following is the best management option for this patient?
A. Surgical lung biopsy
B. Corticosteroids
C. Suppressive antibiotic therapy
D. 24-hour esophageal pH study
Posts: 3,675,934
Threads: 734,342
Joined:
Sep 2021
Reputation:
5
D. but not sure. aspiration less likely in upper lobes but none of other fits. anyway I am confused
Posts: 3,675,934
Threads: 734,342
Joined:
Sep 2021
Reputation:
5
C.
B. if it is primary OP, but it started after her breast Ca rx, so it is secondary, I think the answer will be C.
Posts: 3,675,934
Threads: 734,342
Joined:
Sep 2021
Reputation:
5
correct answer: B
Organizing pneumonia is a pathologic pattern of lung injury that may occur in various clinical settings and must be interpreted in the clinical context. This pattern is classically seen in the idiopathic interstitial pneumonia cryptogenic organizing pneumonia (COP) (formerly called idiopathic bronchiolitis obliterans organizing pneumonia [BOOP]). This is a disorder of adults with a presentation suggestive of a lower respiratory tract infection. Regardless of the underlying clinical setting, constitutional symptoms are common. Plain chest radiography shows patchy unilateral or bilateral consolidation. On HRCT, airspace consolidation with air bronchograms is seen often with a subpleural or peribronchiolar distribution. Pulmonary physiology is restrictive with a reduced DLCO. Although a surgical lung biopsy is necessary to make a definitive diagnosis, in patients with typical clinical and radiographic features, a transbronchial biopsy that shows the pathologic pattern of organizing pneumonia and lacks features of an alternative diagnosis is adequate to make a tentative diagnosis and start therapy.
Other than the idiopathic form, organizing pneumonia can occur in infections, connective tissue diseases, and as a complication of treatments, such as amiodarone or radiation therapy. Most patients recover with corticosteroid therapy.
Aspiration can result in recurrent episodes of organizing pneumonia, but this patient provides no clinical evidence or risk factors for aspiration or gastroesophageal reflux; therefore evaluation for reflux with a 24-hour pH probe should not be the first consideration. Suppressive antibiotic therapy has no role in the treatment of noninfectious organizing pneumonia.
