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Diffuse Lung Disease |

Organizing Pneumonia: Clinical Presentation and Experience in a Tertiary Hospital in Singapore

Felicia Teo, OTR; Dipika Agrawal, OTR; Ju Ee Seet, OTR
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National University Health System, Singapore, Singapore


Chest. 2013;144(4_MeetingAbstracts):475A. doi:10.1378/chest.1703407
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Abstract

SESSION TITLE: Interstitial Lung Disease Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Organizing pneumonia (OP) is an inflammatory lung disorder with a distinctive histological pattern characterized by the presence of buds of granulation tissue in distal pulmonary airspaces, with overall preserved lung architecture. The etiology may be cryptogenic (COP) or secondary to an underlying inflammatory process (SOP). A hallmark of OP is its usually dramatic response to steroid therapy, and overall prognosis is good. Published case series reflect considerable heterogeneity in the presentation and etiology of OP. We sought to determine diagnostic and treatment-related characteristics of patients with OP in our hospital.

METHODS: Retrospective review of medical records of 52 patients with biopsy-proven OP diagnosed between 2008 to 2012. Clinical, laboratory, radiological and pathological data were analyzed.

RESULTS: The mean age at presentation was 58 years old. 64% of patients were Chinese. The commonest symptoms were cough (73%), fever (35%) and breathlessness (25%). Secondary OP occurred in 26 patients. SOP was associated with autoimmune disorders (6%), hematological malignancy (17%), solid organ malignancy (15%), transplant (10%), infection (19%) and drugs (15%). Physiologic restriction was the most common pulmonary function abnormality. Radiographic patterns included focal OP (27%), typical OP (17%), infiltrative OP (15%); 39% were non-specific. All patients with autoimmune SOP had typical radiologic OP features. Histology was obtained by transbronchial biopsy (54%), percutaneous lung biopsy (25%) and surgical lung biopsy (29%). Nineteen patients (37%) were treated with steroids, of which only 1 relapsed. At 1 year, 9 patients were lost to follow-up and 2 died after initially improving with ICU care.

CONCLUSIONS: Most cases of biopsy-proven SOP were associated with underlying malignancy in our institution, likely confounded by the increased frequency in which this group of patients are subject to more invasive testing to exclude neoplasia, disease recurrence or treatment-related complications. The relatively uncommon occurrence of radiographic typical and infiltrative OP may reflect a more conservative approach among local physicians towards seeking definitive histology in diffuse parenchymal lung diseases.

CLINICAL IMPLICATIONS: Organizing pneumonia may often present with non-specific radiographic abnormalities and an index of suspicion, together with appropriate clinical correlation, is necessary to effect appropriate management.

DISCLOSURE: The following authors have nothing to disclose: Felicia Teo, Dipika Agrawal, Ju Ee Seet

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boop ; singapore

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