Cryptogenic organizing pneumonia overview: Difference between revisions

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===Chest X Ray===
===Chest X Ray===
===Electrocardiogram===
There are no ECG findings associated with [[cryptogenic organizing pneumonia]].


===CT===
===CT===

Revision as of 23:55, 6 March 2018

Cryptogenic Organizing Pneumonia Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:

Overview

Cryptogenic organizing pneumonitis is a rapidly developing pneumonia-like illness characterised by lung inflammation and scarring that obstruct the small airways and air sacs of the lungs (alveoli). Its name is derived from the fact that it closely mimics pneumonia infections. (The term COP is used in Europe and BOOP in North America.)

Bronchiolitis obliterans organizing pneumonia is an inflammation of the bronchioles and surrounding tissue in the lungs. BOOP is often caused by a pre-existing chronic inflammatory disease like rheumatoid arthritis. In cases where no cause is found, the disease is called cryptogenic organizing pneumonia.

The clinical features and radiological imaging resemble infectious pneumonia. However, diagnosis is suspected after there is no response to multiple antibiotics, and blood and sputum cultures are negative for organisms.

Historical Perspective

Initial descriptions of organizing pneumonia can be traced back to 1877 Paris, in the lectures of J.M. Charcot. The first report of non-infectious organizing pneumonia without an identifiable underlying etiology was published in 1983. Soon after, the term "bronchiolitis obliterans organizing pneumonia (BOOP)" was introduced. This nomenclature was abandoned in 2002 by the American Thoracic Society/European Respiratory Society International Consensus Panel and the term cryptogenic organizing pneumonia was adopted.

Classification

There is no established system for the classification of cryptogenic organizing pneumonia.

Pathophysiology

Cryptogenic organizing pneumonia is an idiopathic diffuse interstitial lung disease that affects the distal bronchioles, respiratory bronchioles, alveolar ducts, and alveolar walls. The injury occurs within the alveolar wall. There is proliferation of granulation tissue which involves alveolar ducts and alveoli. There are 4 phases lead to the formation of mature fibrotic bud.

Causes

Differentiating Cryptogenic organizing pneumonia from Other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications, and Prognosis

Diagnosis

History and Symptoms

Patients with cryptogenic organizing pneumonia may have a positive history of connective tissue diseases, drug intake, malignancy and another interstitial lung disease. Common symptoms are a dry cough, shortness of breath, fever, fatigue and weight loss. Less common symptoms are hemoptysis, chest pain, and night sweats.

Physical Examination

Patients with cryptogenic organizing pneumonia usually appear in mild distress. On examination, the patient is usually febrile, in tachypnea, tachycardia with the regular pulse. On lung auscultation there are bilateral vesicular breath sounds, fine crackles and wheezing is heard.

Laboratory Findings=

Chest X Ray

Electrocardiogram

There are no ECG findings associated with cryptogenic organizing pneumonia.

CT

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

The mainstay of the therapy is pharmacotherapy. Corticosteroids are used as first-line treatment for patients with the symptomatic and progressive disease. Treatment is planned according to the severity of the disease. For treatment of mild disease is to monitor if there is no worsening of symptoms or pulmonary function. If there is worsening of symptoms, macrolides are used in the treatment of mild disease.For persistent or gradually worsening disease, corticosteroids are used for treatment and for severe disease cytotoxic agents are added. Relapses are common with corticosteriods therapy, azathioprine is used.

Surgery

Surgical intervention is not recommended for the management of cryptogenic organizing pneumonia. Resection of the solitary nodule is the treatment for focal organizing pneumonia.

Primary Prevention

Effective measures for the primary prevention of cryptogenic organizing pneumonia is the elimination of the cause and appropriate treatment.

Secondary Prevention

Effective measures for the secondary prevention of cryptogenic organizing pneumonia include educating the patient about the need for early treatment to prevent long term disabling bronchiolitis obliterans and interstitial fibrosis.

References

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