bronchiolitis obliterans; constrictive bronchiolitis; cryptogenic organizing pneumonia; bronchiolitis obliterans with organizing pneumonia (BOOP)
Jump to navigation
Jump to search
Introduction
Bronchiolitis with or without organizing pneumonia (BOOP). Cryptogenic organizing pneumonia is the idiopathic form of BOOP.[2][4] BOOP is a non-specific histologic diagnosis. The diagnosis is one of exclusion.
Etiology
- connective tissue diseases (disease associations)
- silo-filler's lung
- exposure to noxious gases, hazardous inhalents
- pharmaceutical agents
- bleomycin
- amiodarone
- penicillamine
- inhaled cocaine
- radiation therapy
- infection
- viral
- cytomegalovirus
- influenza virus
- respiratory syntitial virus (RSV)
- most common cause of bronchiolitis in young children
- HIV
- bacterial
- Fungal
- viral
- organ transplantation
- chronic eosinophilic pneumonia
- Wegener's granulomatosis
- pulmonary infarcts
- pulmonary granulomas
- vasculitis[2]
- lymphoma[2]
- adenocarcinoma[2]
- pulmonary neoplasms
- idiopathic (BOOP)
Epidemiology
- veterans returning from Iraq & Afghanistan
Pathology
- inflammatory infiltrate of terminal bronchioles
- intraluminal fibrosis in distal airways, alveolar ducts or perialveolar spaces
- obliteration of small airways
- organizing pneumonia in the absence of infection (BOOP)
- extension of exudate & granulation tissue into respiratory bronchioles, alveolar ducts, & alveolar walls
- patchy bilateral alveolar filling with loose plugs of granulation tissue
- a distinct entity without organizing pneumonia is considered separate from BOOP[2]
- extension of exudate & granulation tissue into respiratory bronchioles, alveolar ducts, & alveolar walls
- airflow obstruction
Clinical manifestations
- may follow upper respiratory tract infection
- resembles a flu-like syndrome with acute or subacute onset, or community acquired pneumonia
- patients may be initially treated for pneumonia
- failure to respond to antibiotics
- development of a subacute process
- exertional dyspnea
- cough
- fever may or may not be present
- crackles
- sputum uncommon
Diagnostic procedures
- bronchoscopy:
- Pulmonary function testing:
- restrictive pattern
- diminished DLCO
- generally poorly responsive to bronchodilators
* lung biopsy may not be needed for diagnosis if clinical presentation & CT consistent with cryptogenic organizing pneumonia[2]
Radiology
- chest X-ray
- patchy, diffuse, migratory ground-glass alveolar infiltrates
- patchy air-space consolidation in the lung periphery
- often involves the lower lung fields[2]
- may mimic infectious pneumonia[2]
- high-resolution computed tomography
- mosaic pattern
- ground glass infiltrates with areas of hyperinflation
- centrilobular nodules
- airway thickening
- mosaic pattern
Differential diagnosis
Management
- remove offending agents
- treat underlying disorders
- high-dose glucocorticoids
- generally beneficial with idiopathic form
- 6-12 months in duration, occasionally longer
- relapses common with glucocorticoid taper, but they general respond to a dose increase with slowertaper[2][4]
- adjunct immunosuppressive agents may be needed
- erythromycin may be of value
- prognosis
- generally good with idiopathic form
- may be less favorable when associated with specific disorders
More general terms
References
- ↑ Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 748, 763
- ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 15, 16, 17, 18, 19. American College of Physicians, Philadelphia 1998, 2006, 2009, 2012, 2015, 2018, 2022.
- ↑ Journal Watch, Mass Med Soc 19(23):187 (Dec) 1999
- ↑ 4.0 4.1 4.2 Drakopanagiotakis F, Paschalaki K, Abu-Hijleh M et al Cryptogenic and secondary organizing pneumonia: clinical presentation, radiographic findings, treatment response, and prognosis. Chest. 2011 Apr;139(4):893-900 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20724743
- ↑ Montesi SB, Nance JW, Harris RS, Mark EJ. CASE RECORDS of the MASSACHUSETTS GENERAL HOSPITAL. Case 17-2016. A 60-Year-Old Woman with Increasing Dyspnea. N Engl J Med. 2016 Jun 9;374(23):2269-79. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27276565 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMcpc1516452
- ↑ Lazor R, Vandevenne A, Pelletier A et al Cryptogenic organizing pneumonia. Characteristics of relapses in a series of 48 patients. The Groupe d'Etudes et de Recherche sur les Maladles "Orphelines" Pulmonaires (GERM"O"P). Am J Respir Crit Care Med. 2000 Aug;162(2 Pt 1):571-7. PMID: https://www.ncbi.nlm.nih.gov/pubmed/10934089
- ↑ NEJM Knowledge+ Question of the Week. Jan 26, 2021 https://knowledgeplus.nejm.org/question-of-week/269/
Epler GR et al. Bronchiolitis obliterans organizing pneumonia. N Engl J Med 1985 Jan 17; 312:152 https://www.nejm.org/doi/full/10.1056/NEJM198501173120304
Drakopanagiotakis F et al. Cryptogenic and secondary organizing pneumonia: clinical presentation, radiographic findings, treatment response, and prognosis. Chest 2010 Aug 21; 139:893 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20724743
Cottin V, Cordier JF. Cryptogenic organizing pneumonia. Semin Respir Crit Care Med 2012 Oct; 33:462. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23001801