PURPOSE: Organizing pneumonia (OP) is a histologic pattern that is morphologically distinctive but is nonspecific and can be seen in diverse clinical settings. Focal OP has been described as a discrete form of OP but relatively little is known regarding this clinicopathologic entity. We sought to clarify the clinicoradiologic presentation, underlying causes, and prognosis associated with focal OP.
METHODS: We sought to clarify the clinicoradiologic presentation, underlying causes, and prognosis associated with focal OP by retrospectively reviewing 26 consecutive cases diagnosed by surgical lung biopsy over an 8-year period from January 1, 1997 to December 31, 2004.
RESULTS: All patients presented with a unifocal opacity detected on chest radiography (20 patients) or computed tomography (6 patients). At the time of presentation, 10 (38%) patients had symptoms including cough, shortness of breath, or chest pain; 16 patients were asymptomatic. Contrast-enhancement computed tomographic (CT) study or positron emission tomography (PET) scan was performed in 11 patients and was positive in all. Surgical procedures included wedge resection in 21 patients (81%), segmentectomy in 3 patients (11%) and lobectomy in 2 patients (8%). Three case of focal OP (12%) were related to infections but the remaining cases were cryptogenic. Follow-up over a median interval of 11 months (range, 1 to 71 months) yielded no recurrence of OP.
CONCLUSION: Radiologic features of focal OP are often indistinguishable from lung cancer and include positivity on contrast-enhancement CT study and PET scan. Most cases of focal OP are cryptogenic and infection is identified in a minority of cases. Surgical resection alone appears to suffice in the management of cryptogenic focal OP.
CLINICAL IMPLICATIONS: Focal OP does not recur after surgical resection and does not require corticosteroid therapy commonly employed for non-focal organizing pneumonia.
DISCLOSURE: Fabien Maldonado, No Financial Disclosure Information; No Product/Research Disclosure Information