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Organizing pneumonia
This document discusses various lung conditions including bronchiolitis obliterans, organizing pneumonia, and interstitial lung disease. It defines key terms and describes the symptoms, causes, diagnosis, and treatment of these conditions. Bronchiolitis obliterans involves scarring and obstruction of the bronchioles. Organizing pneumonia refers to unresolved pneumonia where exudates persist and cause fibrosis. Interstitial lung disease is a class of diffuse lung diseases involving inflammatory responses with varying degrees of pulmonary fibrosis. Specific forms like BOOP, COP, and IPF are mentioned along with their clinical presentation and pathological features.
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Organizing pneumonia
- 1. ORGANIZING PNEUMONIA BRONCHIOLITIS OBLITERANS ORGANISINGPNEUMONIA Presented by Dr. MohamedA/AzizOmerMustafa Consultantchestphysician MD Respirato ry medicine SMSB
- 2. Idiopathic BRONCHIOLITIS OBLITERANS ORGANISING PNEUMONIA(BOOP) CRYPTOGENIC ORGANISING PNEUMONIA (COP) SECONDRY ORGANIZING PNEUMONIA (SOP)
- 3. Terms • Bronchiolitis Bronchiolitis obliterans(BO) Obliterative bronchiolitis (OB) Constrictive bronchiolitis(CB) • Bronchiolitis obliterans syndrome (BOS) • Pneumonia • Organizing pneumonia • Idiopathic interstitial pneumonia ( diffuse alveolar damage)
- 4. Bronchiolitis • Is aninflammatory reaction that follows damage to the bronchiolar epithelium of the small conducting airways Subsequent healing leads to excessive proliferation of granulation tissue within the airway walls , lumen or both. Depending on disease stage the repair process may cause narrowing and distortion of the small airway (constrictive bronchiolitis ) or complete obliteration ( bronchiolitis obliterans)
- 5. BRONCHIOLITIS OBLITERANS • Rareform of non-reversible Obstructive lung disease • Scarring • Polyploidy obliteration of the lumen of the bronchioles without involving of the distal lung parenchyma. • Infants - adenovirus
- 6. BRONCHIOLITIS OBLITERANS • Rareform of non-reversible Obstructive lung disease • Scarring • Polyploidy obliteration of the lumen of the bronchioles without involving of the distal lung parenchyma. • Infants - adenovirus
- 7. BRONCHIOLITIS OBLITERANS SYMPTOMS &SIGNS • Dry cough • SOB • WHEEZES • FEV1 16-21% • Desaturation
- 8. BRONCHIOLITIS OBLITERANS CAUSES • Viruses •Collagen vascular diseases • Transplant rejection • Stevens-Jonson's syndrome • Pneumocystis Juversi pneumonia • Drug reaction • Aspiration • Bronchopulmonary dysplasia-prematurity • Toxic fumes
- 9. BOS a distinct clinicalentity occurring in the transplanted lung involves the small airways primarily should not be confused with BO or BOOP
- 10. PNEUMONIA - PNEUMONITIS •Inflammatory condition of the lung affecting primarily the microscopic airspaces known as alveoli . • Congestion , hepatization , resolution • …. Viruses , bacteria ,fungi , parasites • > 100 strains identified • Mixed infection 45% children : 15% adults • Isolation of causative agent 50% despite careful testing
- 11. Pneumonitis • Certain drugs •Chemical burns • Autoimmune diseases • Radiation • Thermal injuries
- 12. HISTORY • HIPPOCRATES 460-370BC • 12 November world pneumonia day • 450 million /year • 4 million deaths /year • 7% world’s total deaths • Greatest < 5 >75 yrs • 8th leading death in the states 2009
- 13. PNEUMONIA IMAGING • CXRdoes not always match the severity of pneumonia • Not reliably separate between bacterial infection and viral infection • CXR typically clear within one month
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- 17. Interstitial lung disease •Is a class of diffuse lung diseases . • It is a common pathological response of the lung to a wide variety of known & unknown cause . • It is often referred to interstitial pneumonia , IP or interstitial lung disease ILD • Until 1960 IPF remained largely a clinical diagnosis considered as a single entity • Has been felt to be a terminal disease with poor prognosis because of lack of response to immunosuppressive therapy only 30% respond • only 30% histopathology done
- 18. ILD Several acute andchronic lung disorders with variable degrees of pulmonary fibrosis ,variable degree of disease progression & variable response to treatment. Retrospective review of clinical & histopathology data allows IPF to be classified into distinct subsets that differ in clinical course , prognosis & response to treatment .
- 19. ILD • NSIP ,LIP , DIP ,RBI lung disease , UIP , OP • In some ILDs , the small airways- the respiratory and terminal bronchioles- are primarily affected . respiratory bronchiolitis-associated interstitial lung disease (RBILD) idiopathic , smoking related in contrast to BO .
- 20. Known factors orinsults lead to Interstitial lung disease • Drugs : antineoplastic (bleomycin , methotrexate ) : antimicrobial (nitrofrantoin , penicillin ) :amidorone : hydroclorothiazide • Hypersensitivity pneumonia Farmer’s lung , pigeon breeder’s lung . Dusts: Asbestos , silica Viral agents … mycoplasma pneumonia . CD
- 21. ILD . It is importantto differentiate terms used to define clinical entities and terms describing the pathologic lesions of these disorders . Clinical syndromes IPF,CFA ,idiopathic BOOP,COP,BO,BOS ,Hamman-Rich syndrome . Pathological:UIP , LIP , giant cell interstitial pneumonitis , diffuse alveolar damage, non classifiable interstitial pneumonia , BOOP .
- 22. DD ILD • Clinical setting:- •First: requires consideration of a variety of other pathological processes that mimic the interstitial disorders in appropriate clinical setting • Second: Physician should be aware of at least 150 other clinical entities & situations associated with ILD • Third: Owing the broad DD & the availability of various evolving invasive & non-invasive diagnostic techniques, the best approach to use is to establish a specific diagnosis which is frequently difficult to determine • Fourth: In a significant proportion of patients a conclusive cause can't be ascertained even when the most invasive diagnostic pathways are taken. • Finally , even when a specific diagnosis is made, an effective therapeutic regimen is not available for many patients with ILD
- 23. ???????? BOOP Bronchiolitis obliterans organizingpneumonia Is a type of diffuse INTERSTITIAL LUNG DISEASE that affects the distal bronchioles , respiratory bronchioles , alveolar ducts and alveolar wall. Type of lung injury and repair Failure of resolution of acute pneumonia The primary area of injury is within the alveolar wall.
- 24. BOOP Hx • Asa distinct clinical entity 1st described by Davison in 1983 • Gary Epler 1985 gave the name BOOP • Inflammation of the bronchioles & surrounding tissue in the lung. • Non infectious- infectious • Complication of an existing chronic inflammatory disease such as RA • Side effect of certain medication such as amidarone • MF 1:1 • Age 50-60 20-80 • No relation to smoking
- 25. Organizing pneumonia • Refersto unresolved pneumonia in which alveolar exudates persists & eventually undergo fibrosis . . presence of buds of granulation tissue progressing from fibrin exudates to loose collagen containing fibroblast. Accessory finding in other inflammatory diseases such as vasculitis . It may also be a feature of organizing stage of ARDS • A complication of an existing chronic inflammatory disease or a side effect of certain medication .
- 26. • organizing Pneumoniaof determined causes • organizing Pneumonia of unknown cause occurring in a specific context causes • Cryptogenic organizing pneumonia
- 27. Undetermined causes oforganizing Pneumonia • RA , Sjorgen syndrome---------- SLE ,SS • Sweet”s disease • HCV thyroiditis • Crhons disease…..UC • Behcets”s …. Wegener”s granulomatosis ….PN • Polymyalgia Rheumatica • Myelodysplasia • Leukemia ….. Cancer • Mesangiocapillary GN • Chronic rejection …. Graft versus host disease
- 28. Determined causes oforganizing Pneumonia • Infection • Drugs • Radiation
- 29. • It waslong been known that radiation may induce radiation pneumonitis • However a syndrome similar to COP has been identified recently • It differs strikingly from usual radiation pneumonitis in that the pulmonary infiltrate occur or migrate outside the radiation fields add respond good to steroids. • Interestingly, unilateral breast irradiation, whether or not it results in pneumonitis , has been shown to induce bilateral lymphocytic alveolitis with activated CD4+Tcells
- 30. Infectious causes oforganising pneumonia • Bacteria Chlamydia pneumoniae Coxiella burnetii Legionella pneumophila Mycoplasma pneumoniae Nocardia asteroides Pseudomonas aeruginosa Serratia marcescens Staphylococcus aureus Streptococcus group B (newborn treated by extracorporeal oxygenation) Streptococcus pneumoniae
- 31. Infectious causes oforganising pneumonia cont….. • Viruses Herpes virus Human immunodeficiency virus Influenza virus Parainfluenza virus • Parasites Plasmodium vivax • Fungi Cryptococcus neoformans Penicillium janthinellum Pneumocystis carinii (in AIDS )
- 32. Clinical approach • MedicalHx , environmental factors, occupational exposures, medication & drug usage, FH • Age , smoking, sex • Onset & Duration of symptoms • Rate of disease progression • Extra pulmonary symptoms
- 33. Clinical approach …cont. •Acquired immunodeficiency & transplant • Diffuse neoplasia • CHF • Pulmonary vascular disorder • CBC, ESR, LFT, electrolytes, RFT
- 34. BOOP diagnosis • Diagnosisis suspected after no response to multiple antibiotics & blood & sputum cultures are –ve for organisms . Clinical picture & radiological images resemble infectious pneumonia • CXR similar to an extensive pneumonia wide spread white patches small nodular opacities 50% & large nodules in 15% • Preservation of normal lung volume • Migrate • Persists or progresses
- 35. BOOP – CT •CT may be used to confirm the diagnosis ( findings are typical enough to allow the doctor to make the diagnosis without ordering additional tests) • …airspace consolidation with airbronchogram , lower zone predominance , sub pleural or peribronchial distribution 50%. • Ground glass appearance in most pt , honeycombing in some • Diffuse bilateral infiltratation • as a solitary focal lesion associated usually with subacute or chronic inflammatory illness, it occurs in the upper lobes and may cavitate. • .
- 36. BOOP - histopathology •Confirmation • Broncoscopic biopsy ! • VATS • Histology: presence of polyploidy plugs of loose organizing connective tissue ( Masson bodies ) within the alveolar ducts , alveoli , bronchioles . • Intraluminal polyps in respiratory bronchioles , alveolar ducts , alveolar spaces . • Accompanied by organizing pneumonia in the more distant parenchyma ( proliferative bronchitis)
- 37. Diagnosis of exclusion •COP is a diagnosis of exclusion . • Once confirmation done , physician has to rule out :- Chronic esinophilic pneumonia Hypersensitivity pneumonia Bacterial …. Viral CD Drug reaction
- 38. TREATMENT • Spontaneous • Macroloids •Steroids • Cytotoxic drugs • Transforming growth factor , pirfenidone
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- 40. Typical imaging patternof organising pneumonia with patchy alveolar opacities on chest radiograph. Cordier J Thorax 2000;55:318-328 Copyright © BMJ Publishing Group Ltd & British Thoracic Society. All rights reserved.
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