Clinical Features Of Cryptogenic Organizing Pneumonia

BACKGROUND:Cryptogenic organizing pneumonia is a nonspecific inflammatory pulmonary process, defined histopathologically by intra-alveolar buds of granulation tissue,consisting of intermixed myofibroblasts and connective tissue.Cryptogenic organizing pneumonia with low incidence is often misdiagnosed or missed.However,rapid clinical and imaging improvement is obtained with corticosteroid treatment.In this study,we retrospectively reviewd 34 subjects wih cryptogenic organizing pneumonia confirmed by lung biopsy in order to analyze the clinical,radiologicah,pathological features of cryptogenic organizing pneumonia.OBJECTIVE:To analyze the clinicah,radiologicah,pathological features of cryptogenic organizing pneumonia.METHODS:34 subjects with cryptogenic organizing pneumonia confimed by lung biopsy in Zhongshan Hospital,Fudan University,Shanghai from January of 2004 to March of 2009 were retrospectively reviewed.The clinical-pathological characteristics,radiological features,response to treatment were obtained from medical records.RESULTS:There were 19 females and 15 males,with a mean age of 56.97±14.22 years.The presentations included mild cough,clear sputum,dyspnea and fever.Since the most common manifestations were nonspecific,diagnosis was usually delayed(59.94±21.42 days) with misuse of antibiotics.None of them had dust inhalation,10 were smokers.The three main characteristic imaging patterns of cryptogenic organizing pneumonia consisted of multiple alveolar opacities,solitary opacity and infiltrative opacities,and the multiple slveolar opacities were ofen migratory.A mild restrictive ventilatory defect was the most commom abnormality in lung function test,and hypoxaemia at rest is usually mild.The C-reactive protein level and erythrocyte sedimentation rate were increased.The pathological characteristic was intra-alveolar buds of granulation tissue,consisting of intermixed myofibroblasts and connective tissue.Corticosteroid treatment in COP resulted in rapid clinical improvement and clearing of the opacitiese on chest imaging without significant sequelae.However,relapses were common upon stopping or reduction of coticosteroids.CONCLUSIONS:The clinical-radiological-pathological diagnosis is the most important diagnostic method.The diagnosis of COP requires the exclusion of any possible cause.Corticosteroid treatment in COP results in rapid clinical improvement and clearing of the opacities on chest imaging.But relapses were common upon stopping or reduction of coticosteroids.