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Original Research: DIFFUSE LUNG DISEASE |

Cryptogenic and Secondary Organizing Pneumonia: Clinical Presentation, Radiographic Findings, Treatment Response, and Prognosis

Fotios Drakopanagiotakis, MD; Koralia Paschalaki, MD; Muhanned Abu-Hijleh, MD, FCCP; Bassam Aswad, MD; Napoleon Karagianidis, MD; Emmanouil Kastanakis, MD; Sidney S. Braman, MD, FCCP; Vlasis Polychronopoulos, MD, FCCP
Author and Funding Information

From the Third Pulmonary Medicine Department (Drs Drakopanagiotakis, Paschalaki, Karagianidis, Kastanakis, and Polychronopoulos), Sismanoglion General Hospital, Maroussi, Greece; the Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine (Drs Abu-Hijleh and Braman), and the Department of Pathology (Dr Aswad), Rhode Island Hospital–The Alpert Medical School of Brown University, Providence, RI.

Correspondence to: Muhanned Abu-Hijleh, MD, FCCP, Division of Pulmonary, Critical Care and Sleep Medicine, Rhode Island Hospital–The Alpert Medical School of Brown University, 593 Eddy St, APC Bldg, 7th Floor, Providence, RI 02903; e-mail: Muhanned_Abu-Hijleh@Brown.edu


Drs Drakopanagiotakis, Paschalaki, and Abu-Hijleh contributed equally to this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;139(4):893-900. doi:10.1378/chest.10-0883
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Background:  Organizing pneumonia (OP) is a distinct clinical and pathologic entity. This condition can be cryptogenic (COP) or secondary to other known causes (secondary OP). In the present study, we reviewed the features associated with COP and secondary OP in patients from two teaching hospitals.

Methods:  The medical records of 61 patients with biopsy-proven OP were retrospectively reviewed. Forty patients were diagnosed with COP and 21 patients with secondary OP. The clinical presentation, radiographic studies, pulmonary function tests (PFTs), laboratory data, BAL findings, treatment, and outcome were analyzed.

Results:  The mean age at presentation was 60.46 ± 13.57 years. Malaise, cough, fever, dyspnea, bilateral alveolar infiltrates, and a restrictive pattern were the most common symptoms and findings. BAL lymphocytosis was observed in 43.8% of patients with OP. The relapse rate and mortality rate after 1 year of follow-up were 37.8% and 9.4%, respectively. The in-hospital mortality was 5.7%. The clinical presentation and radiographic findings did not differ significantly between patients with COP and secondary OP. A mixed PFT pattern (obstructive and restrictive physiology) and lower blood levels of serum sodium, serum potassium, platelets, albumin, protein, and pH were observed among patients with secondary OP. Higher blood levels of creatinine, bilirubin, Paco2, and BAL lymphocytes were also more common among patients with secondary OP. There were no differences in the relapse rate or mortality between patients with COP and secondary OP. The 1-year mortality correlated with an elevated erythrocyte sedimentation rate, low albumin, and low hemoglobin levels.

Conclusions:  The clinical and radiographic findings in patients with COP and secondary OP are similar and nonspecific. Although certain laboratory abnormalities are more common in secondary OP and can be associated with worse prognosis, they are likely due to the underlying disease. COP and secondary OP have similar treatment response, relapse rates, and mortality.

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