Two Cases Reports Of Cryptogenic Organizing Pneumonia And Review

Objective: Through 2 cases of cryptogenic organic pneumonia and review literature reports,to improve the attention of clinicians to cryptogenic organic pneumonia and reduce the abuse of antibiotics,shorten the hospitalization time,and save the hospitalization cost.Methods: Report two cases of cryptogenic organic pneumonia diagnosed by pathology in the Department of Respiratory medicine of Jinan Central Hospital Affiliated to Shandong University.A retrospective analysis was conducted on patients with complete clinical data confirmed by pathology from 2014 to 2019 by using the keyword "cryptogenic organic pneumonia",to explore the clinical,imaging,pathological and therapeutic features of cryptogenic organic pneumonia.Results: We analyse nineteen references and 23 cases.All patients were confirmed by pathology.There were There was no difference in incidence between men and women,ranging in age from 20 to 80 years old.Majority of symptoms include cough,expectoration,fever,chest tightness,and hemoptysis.Laboratory tests showed elevated inflammatory markers.The lung function examination was dominated by restricted ventilation dysfunction.The CT findings of the chest were complex and varied,including patchy consolidation,bronchogram,ground glass,nodular shadow,pleural effusion,striated shadow,and bilateral lung involvement.The initial misdiagnosis rate was 100%.All patients were confirmed by pathology.The pathological findings were granulation tissue formation in the alveolar cavity.A large number of foam macrophages,interstitial lymphocytes,and plasma cells with light to moderate infiltration can be seen in the empty alveolar space.Cryptogenic organic pneumonia has a good response to glucocorticoid.In the process of glucocorticoid reduction,if the dose is not standardized,easy to cause recurrence.Conclusion: Clinical-image-pathology multidisciplinary diagnosis model is a widely recognized diagnosis and treatment model.Diagnosis and differential diagnosis are the key points of this disease,and clinical manifestations combined with imaging are the key for clinicians to make early diagnosis of this disease.COP should be highly suspected for patients with the following characteristics :(1)subacute onset,and cough,expectoration and fever are the main clinical manifestations.(2)the white blood cell count and c-reactive protein were increased,the erythrocyte sedimentation was increased rapidly,and the pathogenic examination was negative.(3)the imaging changes were varied,and the lesions could be migratory,as shown by air bronchogram.(4)anti-infection treatment was ineffective,and other causes of secondary organic pneumonia were excluded.(5)pathological changes were manifested as granulation tissue formation in the alveolar cavity,where a large number of foam macrophages were observed.Once the pathological manifestations are organic pneumonia with granuloma or necrosis at the same time,the underlying organic pneumonia will be considered first.With the popularity of fiberoptic bronchoscopy,the maturity of percutaneous lung biopsy technology and the development of thoracoscopy,there are more and more means to obtain pathological tissue.Through pathological tissue,a clear diagnosis can be made.For patients with high suspicion of the disease due to lack of access to the pathology,diagnostic therapy can also be effective in diagnosis.Therefore,it is necessary to raise the awareness of this disease.The treatment effect of glucocorticoid is good,but the amount of glucocorticoid should be decreased,otherwise it is easy to cause recurrence.