Cryptogenic Organizing Pneumonia (COP)

DIAGNOSIS

SYMPTOMS

  • Productive cough2
  • Progressive or mild dyspnea1
  • Other common symptoms:1,2
    • Anorexia
    • Weight loss
    • Sweats
    • Chills
    • Intermittent fever
    • Myalgia
  • Crackles may be localized or widespread throughout the lungs1,2

DIAGNOSTIC TESTS

Clinical history1

Infections/Drugs/Comorbid diseases

  • Connective tissue disease (CTD)
  • Thoracic radiotherapy for breast cancer
  • Inflammatory bowel disease
  • Cancer
  • Exposure to drugs
  • Aspiration
  • Common variable immune deficiency (less common)
  • Toxic exposures (less common)

Complete blood count (CBC)2

  • Raised erythrocyte sedimentation rate
  • Elevated C-reactive protein
  • Peripheral blood neutrophilia

Pulmonary function tests2

  • Lung volumes are normal in about 75% of patients
  • Restrictive pattern (mild to moderate)
  • Reduced DLCO
  • Mild resting hypoxemia

HRCT4

  • Features: Airspace consolidation, mild bronchial dilatation, ground-glass opacities, large nodules are rare
  • Distribution: Patchy, peripheral or peribronchial, basal predominance, sometimes sparing of subpleural space, migration tendency

Bronchoalveolar lavage2

  • Increased number and proportion of lymphocytes
  • Decreased ratio of CD4+ to CD8+ cells
  • Increased number of neutrophils and eosinophils

Surgical lung biopsy is not always necessary1

  • Only typical cases at imaging with compatible clinical and BAL features should be treated without biopsy1
  • Patchy distribution of intraluminal organizing fibrosis in distal airspaces, preservation of lung architecture, uniform temporal appearance4

Chest X-ray

  • Bilateral or unilateral areas of consolidation with patchy distribution2

See also

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Interstitial lung disease in systemic sclerosis with a focus on chest CT

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