Bronchiolitis obliterans organizing pneumonia: Difference between revisions
Kashish Goel (talk | contribs) No edit summary |
|||
| Line 17: | Line 17: | ||
==Overview== | ==Overview== | ||
==Symptoms== | ==Symptoms== | ||
Revision as of 14:22, 24 September 2012
|
Pneumonia Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Bronchiolitis obliterans organizing pneumonia On the Web |
|
American Roentgen Ray Society Images of Bronchiolitis obliterans organizing pneumonia |
|
Risk calculators and risk factors for Bronchiolitis obliterans organizing pneumonia |
| Bronchiolitis obliterans organizing pneumonia | |
| DiseasesDB | 31684 |
|---|---|
| eMedicine | radio/117 |
| MeSH | D018549 |
Editor(s)-in-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-632-7753; Philip Marcus, M.D., M.P.H.[2]
Overview
Symptoms
- Cough
- Dyspnea
- Influenza-like symptoms
- febrile illness
- widespread crackles
- mild resting hypoxemia
On examination, crackles are common, but clubbing is not. Laboratory findings are nonspecific. Plain chest radiography shows normal lung volumes, with characteristic patchy unilateral or bilateral consolidation. Small nodular opacities occur in up to 50% of patients and large nodules in 15%. On HRCT, airspace consolidation with air bronchograms is present in more than 90% of patients, often with a lower zone predominance A subpleural or peribronchiolar distribution is noted in up to 50% of patients. Ground glass or hazy opacities associated with the consolidation are detected in most patients. Pulmonary physiology is restrictive with a reduced DLCO. Airflow limitation is uncommon; gas exchange is usually abnormal and mild hypoxemia is common. Bronchoscopy with BAL reveals up to 40% lymphocytes, along with more subtle increases in neutrophils and eosinophils. In patients with typical clinical and radiographic features, a transbronchial biopsy that shows the pathologic pattern of organizing pneumonia and lacks features of an alternative diagnosis is adequate to make a tentative diagnosis and start therapy. On surgical lung biopsy, the histopathologic pattern is organizing pneumonia with preserved lung architecture; this pattern is not exclusive to BOOP and must be interpreted in the clinical context. Most patients recover with corticosteroid therapy. A standardized approach to dosing starting at 0.75 mg/kg and weaning over 24 weeks has been shown to reduce total corticosteroid exposure without affecting outcome.