Bronchiolitis obliterans organizing pneumonia: CT features in 14 patients

Bronchiolitis obliterans organizing pneumonia is a disease characterized by the presence of granulation tissue within small airways and the presence of areas of organizing pneumonia. We retrospectively reviewed the chest radiographs, CT scans, and biopsy specimens in 14 consecutive patients with proved bronchiolitis obliterans organizing pneumonia. Six patients were immunocompromised because of leukemia or bone-marrow transplantation. In all patients, 10-mm collimation CT scans were available. In 11 of the 14 patients, select 1.5-mm scans were obtained. The CT findings included patchy unilateral (n = 1) or bilateral air-space consolidation (n = 9), small nodular opacities (n = 7), irregular linear opacities (n = 2), bronchial wall thickening and dilatation (n = 6), and small pleural effusions (n = 4). All patients had areas of air-space consolidation, small nodules, or both. A predominantly subpleural distribution of the air-space consolidation was apparent on the radiographs of two patients and on CT scans of six. Pathologically, the nodules and the consolidation represented different degrees of inflammation in bronchioles, alveolar ducts, and alveoli. Although most of the findings were apparent on the radiographs, the CT scans depicted the anatomic distribution and extent of bronchiolitis obliterans organizing pneumonia more accurately than did the plain chest radiographs.     

Bronchiolitis obliterans with organizing pneumonia versus chronic eosinophilic pneumonia: high-resolution CT findings in 81 patients

OBJECTIVE: The objective of this research was to compare high-resolution CT findings of bronchiolitis obliterans with organizing pneumonia (BOOP) with those of chronic eosinophilic pneumonia (CEP) and to determine whether high-resolution CT can differentiate the two. MATERIALS AND METHODS: We retrospectively reviewed high-resolution CT scans of 38 patients with BOOP and 43 patients with CEP. Without knowledge of the diagnosis, two radiologists evaluated the frequency and distribution of high-resolution CT findings in both groups of patients and made a diagnosis using a three-point scale of confidence. RESULTS: Nodules, nonseptal linear or reticular opacities, and bronchial dilatation were significantly more common in BOOP than in CEP (31.6% vs. 4.7%, p < 0.005; 44.7% vs. 9.3%, p < 0.001; and 57.9% vs. 25.6%, p < 0.005, respectively). Septal line thickening was more frequent in CEP than in BOOP (72.1% vs. 39.5%, p < 0.005). Peribronchial distribution of consolidation was more frequent in BOOP than in CEP (28.9% vs. 9.3%, p < 0.05). A correct diagnosis was made in 69.7% of cases, and the diagnostician was confident in 21.7%. Interobserver agreement was good (kappa = 0.6). CONCLUSION: Although several of the high-resolution CT findings of BOOP and CEP are different, these diseases are differentiated with confidence in only a small percentage of cases.     

Bronchiolitis obliterans organizing pneumonia after bone marrow transplantation: association with human leukocyte antigens

This is the first study reporting the relationship between the development of bronchiolitis obliterans organizing pneumonia (BOOP) and human leukocyte antigen (HLA) in patients with bone marrow transplantation (BMT).The HLA B35 was significantly higher in patients with BOOP than in patients without BOOP after BMT (P = 0.0069). The HLA B35 is important as a host factor for the generation of BOOP after BMT. OBJECTIVE: To assess the relationship between the development of BOOP after BMT and HLA. METHODS: We retrospectively reviewed clinical features and chest computed tomographic scans in 64 patients who underwent allogeneic BMT between March 1990 and September 2004, and evaluated the relationship between HLA and development of BOOP. RESULTS: Development of BOOP was between days 22 and 347 (mean, 114 days). The common computed tomographic findings consisted of patchy consolidation in subpleural and/or peribronchovascular distributions. Frequency of HLA B35 in patients with BOOP development after BMT was significantly higher than in patients without BOOP after BMT (P = 0.0069). There were no significant relationships between the others of this antigen and BOOP development. CONCLUSIONS: Our results suggested that HLA B35 is an important host factor for the generation of BOOP after BMT.     

Bronchiolitis obliterans organizing pneumonia after radiofrequency ablation of lung cancer: report of three cases

The present report describes three cases of a bronchiolitis obliterans organizing pneumonia (BOOP)-like reactive pneumonitis following radiofrequency (RF) ablation for lung cancer. The incidence of BOOP-like reactive pneumonitis after RF ablation at the authors' institution was estimated to be approximately 0.4% (three of 840 sessions). The patients presented with nonspecific symptoms. Computed tomography images showed consolidation or ground-glass opacity in a peripheral-dominant distribution and/or patchy air-space opacities. The disease was nonresponsive to antibiotic therapy but responded favorably to pulse therapy of steroids. BOOP-like reactive pneumonitis should be recognized as a complication following lung RF ablation.     

Bronchiolitis obliterans organizing pneumonia after tangential beam irradiation to the breast: discrimination from radiation pneumonitis

We report a case of bronchiolitis obliterans organizing pneumonia (BOOP) secondary to tangential beam irradiation to the breast, which occurred seven months after the completion of radiotherapy. Although radiation pneumonitis is an alternative consideration, BOOP could be differentiated from it by its relatively late onset and extensive distribution, which did not respect the radiation field. This disease should always be kept in mind in patients with a history of tangential beam irradiation to the breast.     

Bronchiolitis obliterans organizing pneumonia after bone marrow transplantation: high-resolution computed tomography findings in 4 patients

OBJECTIVE: To assess the high-resolution computed tomography (HRCT) appearances of bronchiolitis obliterans organizing pneumonia (BOOP) after bone marrow transplantation (BMT). METHODS: The HRCT scans obtained in 4 patients (2 men and 2 women, age range: 20-50 years, mean age = 36 years) with biopsy-proven BOOP after BMT were reviewed retrospectively by 2 observers for the presence, extent, and distribution of parenchymal abnormalities. RESULTS: All patients demonstrated consolidation and ground-glass opacity. The consolidation was bilateral, patchy, and asymmetric in all patients and was predominantly peribronchovascular in 3 patients and subpleural and peribronchovascular in 1 patient. Ground-glass opacity was patchy and asymmetric in all patients and was bilateral in 3 patients and unilateral in 1 patient. No zonal predominance of either feature could be identified. CONCLUSIONS: The predominant HRCT features of BOOP after BMT are bilateral, patchy, and asymmetric consolidation in a predominantly peribronchovascular distribution with associated ground-glass opacity.     

Bronchiolitis obliterans organising pneumonia simulating bronchial carcinoma

Idiopathic bronchiolitis obliterans organising pneumonia (BOOP) is an uncommon but well-recognised condition that usually presents radiologically as bilateral multifocal patchy areas of consolidation on the chest radiograph and on computed tomography (CT). Five cases are described in which the presenting feature was that of a solitary pulmonary nodule. Four of these nodules showed evidence of cavitation and three patients presented with haemoptysis. In all cases the appearances closely resembled bronchial carcinoma. Received 22 December 1997; Accepted 23 January 1998     

Radiographic manifestations of bronchiolitis obliterans with organizing pneumonia vs usual interstitial pneumonia

The radiographic findings in 24 cases of bronchiolitis obliterans with organizing pneumonia and 16 cases of usual interstitial pneumonia were reviewed and compared. Some cases of bronchiolitis obliterans with organizing pneumonia have been mistaken for usual interstitial pneumonia, although the two diseases have distinct pathologic findings. Clinically, the diseases often have different manifestations. Bronchiolitis obliterans with organizing pneumonia has a better prognosis and often responds well to steroids. This study shows that the radiologic findings of bronchiolitis obliterans include alveolar opacities without lung-volume loss. Patients with usual interstitial pneumonia, however, have bilateral diffuse interstitial opacities with occasional honeycomb changes, and there is loss of lung volume in most patients. These findings suggest that the chest radiograph can aid in distinguishing the two diseases.     

Bronchiolitis obliterans organizing pneumonia: The clinical and radiological features of seven cases and a review of the literature

The clinical and radiological features of seven cases of bronchiolitis obliterans organizing pneumonia (BOOP) are presented and the literature is reviewed. Six of these cases were idiopathic, one patient had rheumatoid arthritis. Detailed respiratory function tests were available in four cases and showed a restrictive defect with impaired gas transfer. The majority of chest radiographs showed consolidation with no zonal preponderance. One case with unilobar consolidation was mistaken for malignancy. Another case with interstitial shadowing was thought to have cryptogenic fibrosing alveolitis. In those cases with consolidation, it was mainly peripheral. Six of the cases showed good response to oral steroid therapy. Open lung biopsy was the principal means by which tissue was obtained for diagnosis. BOOP should be included in the differential diagnosis of multifocal consolidation. The condition is usually responsive to steroid therapy, so it is important to confirm the diagnosis histologically.     

Radiation pneumonitis resembling bronchiolitis obliterans organizing pneumonia after postoperative irradiation for lung cancer: a case report

We report a case of BOOP-type pneumonitis after postoperative irradiation for lung cancer. A 60-year-old woman with adenocarcinoma in the right lung underwent lobectomy followed by radiotherapy of 50.4 Gy. After a shadow of typical radiation pneumonitis was resolved in the irradiated site, two relapses, in which migratory infiltrative shadows appeared outside the radiation field, occurred at 6 and 12 months after the completion of radiotherapy. These shadows disappeared spontaneously at 10 and 18 months after the completion of radiotherapy. The radiological findings and clinical course suggested that BOOP-type pneumonitis was the most likely diagnosis for these lesions. This type of lung damage after radiotherapy of the thoracic region should be identified and properly treated.     

Bronchiolitis obliterans with pneumonic organization. Apropos of a case and review of the literature

The authors report a case of bronchiolitis obliterans with organizing pneumonia (BOOP) pathologically proved. They give an analysis of the radiological semiologic findings on plain-film and high-resolution CT (HR-CT). In 1985, Epler proposed a nosologic status but the review of the literature and the findings of their own case give to the authors, the opportunity to discuss the entity on the clinical, evolutive, radiological and pathological point of view.     

孤立局灶型机化性肺炎的螺旋CT评价

目的探讨机化性肺炎的螺旋CT表现。方法对31例机化性肺炎经胸部平扫与增强扫描的螺旋CT表现进行回顾性分析,评价病变的发生部位、形态、大小、边缘、密度及增强等影像学特点。结果右肺22例(70%),左肺9例(30%)。病灶直径介于0.8～7.0 cm。20例呈团块、片状(65%),10例(32%)呈结节状,1例(3%)呈梭形。形态不规则者27例(87%),表现为楔形、多角形,边缘模糊,形态规则4例(13%),边缘光滑。17例(55%)病灶密度不均匀,其中14例病灶内可见低密度,3例可见空洞;14例(45%)病灶密度均匀。平扫低密度区及空洞增强后无强化,其余实变区域强化明显,强化前后CT差值平均约44 HU。6例(19%)病灶相邻胸膜腔少量局限性积液。结论孤立局灶型机化性肺炎的螺旋CT表现具有一定的特异性,有助于临床的诊断。     

The radiology and terminology of cryptogenic organizing pneumonia.

The clinical features, radiographic and computed tomographic findings of nine patients with histological proof of cryptogenic organizing pneumonia were analysed. Patients present with cough, dyspnoea and malaise and commonly have bilateral multifocal consolidation on chest radiography, which may show resolution or relapse with or without steroid treatment. A good response to steroids is the rule, usually with complete radiological resolution or minimal residual scarring. The relative merits of the terms cryptogenic organizing pneumonia and bronchiolitis obliterans organizing pneumonia, both currently used to describe this entity, are discussed.