Diffuse Lung Disease: Diffuse Lung Disease |

Nodular Cryptogenic Organizing Pneumonia: A Case Report FREE TO VIEW

Xiao-yan Zhang, MD; Bei Wang, MD; Li-Yuan Zheng, MD; Qian-Qian Feng, MD; Qianli Ma, MD; Jiangtao Lin, MD; Ji-Ping Da, MD
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China-Japan Friendship Hospital, Beijing, China

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A192. doi:10.1016/j.chest.2016.02.199
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SESSION TITLE: Diffuse Lung Disease

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, April 17, 2016 at 11:45 AM - 12:45 PM

INTRODUCTION: Patchy airspace consolidation with ground glass attenuation is the most common radiologic finding for cryptogenic organizing pneumonia. But here, we report a case which COP was a presenting feature with a solitary nodule.

CASE PRESENTATION: A 57-year-old man found a nodule in middle lobe of right lung during a routine examination. There were not the symptoms of cough and dyspnea. A lung CT showed a solitary nodule in the middle lobe of right lung. A positron emission tomography-computed tomography showed an elevated glucometabolic activity at at level of pulmonary nodule seen at CT. We used a thoracoscopy pulmonary wedge resection in the therapy of nodule in the middle lobe of right lung (1.3cm) (Fig1) and the nodule in the posterior segment (0.9cm). Open small wedge resection of lung tissue of the right middle lobe showed a nodule-like area with grey, diameter 0.5 cm. Microscopically, spectrum of subacute and chronic changes can be seen. Granulation tissue plugs in respiratory bronchioles and alveolar ducts, and separated from the underlying lung tissue. These changes included areas with organizing pneumonia accompanied by intraluminal proliferation of polypoid fibrous connective tissue with scattered foci of chronic inflammatory cells throughout the interstitium.

DISCUSSION: Patchy air space consolidation is the most consistent finding and is present in 90% of cases[1]. The lower lung zones were involved more often than the upper lung zones[2]. This patient had no respiratory symptom and only a solitary nodule in the middle lobe of right lung. Focal lung nodules in the idiopathic form of COP are seldom found and clinically important as they may mimic lung cancer[3]. Depending on their diameter, solid, part-solid, or pure ground-glass pulmonary nodules may be observed. Pure ground-glass nodules, semi-solid lesions, or solid lesions smaller than 8 mm should be monitored by serial low-dose computed tomography. Since both are composed of granulation tissue. In this case, we found that intra-alveolar and bronchioles plug of fibromyxoid tissue with fibrous thicking of alveolar septa, and separated from the underlying lung tissue, without a background fibrosing lung disease, granulation tissue re-epithelialized and applied to fibrotic lung.

CONCLUSIONS: COP can be presented with a solitary nodule without any symptoms. It should be differentiated carefully from the malignancy nodule.

Reference #1: Lee KS, Kullnig P, Hartman TE, Muller NL. Cryptogenic organizing pneumonia. CT findings in 43 patients. AJR AM J Roentgenol. 1994;62:543-546.

Reference #2: Preidler KW, Szolar DM, Moelleken S, et al. Distribution pattern of computed tomography findings in patients with bronchiolitis obliterans organizing pneumonia. Invest Radiol. 1996;31 (5):251-255.

Reference #3: Iwanaga T, Hirota T, Ikeda T. Air leak syndrome as one of the manifestations of bronchiolitis obliterans organizing pneumonia. Intern Med. 2000;39:163-5.

DISCLOSURE: The following authors have nothing to disclose: Xiao-Yan Zhang, Bei Wang, Li-Yuan Zheng, Qian-Qian Feng, Qianli Ma, Jiangtao Lin, Ji-Ping Da

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