Bronchiolitis Obliterans With Organizing Pneumonia (Boop):Clinicalreport Of Five Cases

Objective:Bronchiolitisobliterans with organizing pneumonia (BOOP) is a distinct clinical and pathologic entity. This condition can be cryptogenic organizing pneumonia (COP) or secondary to other known causes (secondary OP).In the present study, we reviewed the pathogen clinical, radiologic and pathological features of patients with BOOP, improving the ability to the diagnosis and treatment of BOOP.Methods:5patients whose pathological were diagnosed organizing pneumonia were found in our hospital from2004to2011. One of these patients was diagnosed in2009, others were confirmed in2011.All patients were diagnosed by pathology (two were by percutaneous lung biopsy, two were by transbronchial lung biopsy (TBLB), one was by Video-assisted thoracoscopic lung surgery (VAST)). The features of pathogen, clinical, imaging, pathological, diagnosis and treatment were conducted a comprehensive analysis.Results:(1) Four cases were cryptogenic organizing pneumonia (COP), but one of4patients was diagnosed as lung cancer finally, although we didn’t find the cause1year ago. Anther patient was diagnosed as secondary OP witch may be caused by pneumonia.(2)Three of these patients whose age were arranging from29to71were male, who had have smoking. The others were female without smoking. Their disease durations were from1month to24months. The main clinical manifestations were fever, cough, chest tightness, shortness of breath, thin and lung wet rales.(3)There were four patients’lung function test results (one patient’s lung function was normal), three of which results were showed disseminated ventilatory defect, two of which results were pointed restrictive ventilatory defect and one had mixed ventilatory dysfunction. Four patients with blood gas analysis shows simple hypoxia.(4)5white blood cells of patients with normal or mildly elevated.Two of which cases’blood eosinophil cells were mild increased, witch accounted for8.3%∽11.4%. ESR was (53∽77) mm/h.(5) Imaging findings:one case could be seen ground-glass and patchy opacities; one case was miliary and small nodular opacities; three cases were with single large areas of dense shade.(6) Treatment and outcome:three cases were treated with prednisone, the treatment continued for six months. The disease symptoms were improved and the lung function and imaging findings were turned for the better. We have been followed up two of the patients with no recurrence. However, the symptoms of one patient were recurrence after one year, who was finally diagnosed as pulmonary poorly differentiated adenosquamous carcinoma, having been given chemotherapy. We found that the Cancer has met astasizde to the liver currently. Two patients weren’t treated with glucocorticoid, one of them losing the visit.(7) Three cases’ clinical diagnosis did not match the pathological, which were diagnosed as inflammatory pseudotumor, eosinophil pneumonia and pneumonia. All patients had been given antibiotic treatment for2-4weeks. One patient had been given anti-tuberculosis treatment for a month.Conclusions:The clinical and imaging features of BOOP are nonspecific, whose diagnosis depends on pathology. There was easily misdiagnosis and missed diagnosis in clinical. Glucocorticoid treatment could be effective. However, the prognosis of the secondary BOOP was associated with the primary disease. Follow-up is also important after treatment, in order to understand the rate of recurrence and cure of BOOP.