• BLADE T2WI
• Magnetic resonance imaging
• diffusion weighted imaging
• focal organizing pneumonia
• lung cancer
• radial VIBE

• Humans
• Female
• Male
• Diagnosis, Differential
• Middle Aged
• Lung Neoplasms/diagnostic imaging
• Retrospective Studies
• Magnetic Resonance Imaging/methods
• Cryptogenic Organizing Pneumonia/diagnostic imaging
• Tomography, X-Ray Computed/methods
• Aged
• Lung/diagnostic imaging
• Adult
• Sensitivity and Specificity
• Aged, 80 and over
• Organizing Pneumonia

• BOOP
• Bronchiolite oblitérante avec organisation pneumonique
• Bronchiolitis obliterans organizing pneumonia
• Cancer
• Cryptogenic organizing pneumonia
• Pneumopathie organisée cryptogénique
• Pneumopathie radique
• Radiation pneumonitis
• Radiotherapy
• Radiothérapie

• Female
• Humans
• Middle Aged
• Breast Neoplasms/radiotherapy
• Cryptogenic Organizing Pneumonia/etiology
• Radiation Injuries/etiology
• Radiation Injuries/complications
• Risk Factors

• Humans
• Female
• Cryptogenic Organizing Pneumonia/etiology
• Aged
• Breast Neoplasms/radiotherapy
• Breast Neoplasms/surgery
• COVID-19/complications
• Arthritis, Rheumatoid/radiotherapy
• Arthritis, Rheumatoid/complications
• SARS-CoV-2
• COVID-19 Vaccines/adverse effects

• Adalimumab
• immunosuppression
• organising pneumonia
• tuberculosis

• Humans
• Female
• Adult
• Diagnosis, Differential
• Tomography, X-Ray Computed
• Adalimumab/therapeutic use
• Tuberculosis, Pulmonary/drug therapy
• Tuberculosis, Pulmonary/diagnosis
• Colitis, Ulcerative/drug therapy
• Colitis, Ulcerative/diagnosis
• Cryptogenic Organizing Pneumonia/diagnosis
• Cryptogenic Organizing Pneumonia/diagnostic imaging
• Cryptogenic Organizing Pneumonia/drug therapy
• Anti-Inflammatory Agents/therapeutic use

• cryptogenic organizing pneumonia
• solanine poisoning

• Humans
• Male
• Adult
• Cryptogenic Organizing Pneumonia/diagnosis
• Cryptogenic Organizing Pneumonia/drug therapy
• Cryptogenic Organizing Pneumonia/chemically induced
• Glucocorticoids/therapeutic use
• Tomography, X-Ray Computed
• Oxygen Inhalation Therapy

• Bronchiolitis obliterans
• Constrictive bronchiolitis
• Fibrosis
• Inflammation
• Review
• Vasculopathy

• Humans
• Bronchiolitis Obliterans/diagnosis
• Bronchiolitis Obliterans/etiology
• Biopsy
• Dyspnea
• Phenotype

• Cryptogenic organizing pneumonia
• Misdiagnosis
• Mycobacterium tuberculosis
• Secondary organizing pneumonia
• tNGS

• WSN-160 The Six Talent Peaks Project in Jiangsu Province

• interstitial lung disease
• lupus
• organizing pneumonia

• acute fibrinous organizing pneumonia
• cicatrices organizing pneumonia
• clarithromycin
• cryptogenic organizing pneumonia
• prednisone
• secondary organizing pneumonia

• Cryptogenic organizing pneumonia
• Idiopathic interstitial pneumonia
• Neumonía intersticial idiopática
• Neumonía organizada
• Neumonía organizada criptogenética
• Organizing pneumonia

• Atoll sign
• Organising pneumonia
• Phenytoin

This case report describes a 58-year-old, never-smoking housewife with chief complaints of progressively worsening cough, dyspnea, and intermittent fever, who was initially misdiagnosed with community-acquired pneumonia (CAP). However, her pulse oximetry oxygen saturation continued to decline, and eventually, she underwent an endotracheal intubation. Fortunately, transbronchial cryobiopsy (TBCB) assisted by extracorporeal membrane oxygenation (ECMO) was performed in the most critical situation, and it revealed an organizing pneumonia (OP) pattern. OP describes a histological pattern of acute or subacute pulmonary damage, which may be idiopathic or associated with a known or unknown underlying disease. A definitive diagnosis of OP usually obtained from pathology, and surgical lung biopsy with large lung tissue is recommended. However, since the surgical lung biopsy was not convenient for this patient after mechanical ventilation, bedside TBCB supported by ECMO was selected. To our knowledge, we are the first to report the pathological diagnosis of ECMO assisted TBCB in acute respiratory failure. When oxygenation cannot be maintained after endotracheal intubation and surgical lung biopsy is not feasible, ECMO-supported TBCB may be a good choice to obtain lung tissue for histopathological diagnosis in patients with acute lung injury of unknown etiology.

• acute fibrinous and organizing pneumonia
• cryptogenic organizing pneumonia
• focal organizing pneumonia
• organizing pneumonia
• secondary organizing pneumonia

• Bronchiolitis Obliterans/complications
• Cryptogenic Organizing Pneumonia/diagnostic imaging
• Cryptogenic Organizing Pneumonia/etiology
• Humans
• Lung/pathology
• Lung Diseases, Interstitial/complications
• Pneumonia/complications

• P30 CA008748 NCI NIH HHS

• Idiopathic pulmonary fibrosis
• Interstitial lung disease
• Obstructive lung disease
• Progressive fibrosing ILD

• Humans
• Lung
• Lung Diseases, Interstitial/complications
• Lung Diseases, Obstructive/diagnosis
• Lung Diseases, Obstructive/epidemiology
• Male
• Phenotype
• Prospective Studies
• Retrospective Studies
• Vital Capacity

• Cryptogenic Organizing Pneumonia/diagnosis
• Cryptogenic Organizing Pneumonia/drug therapy
• Cryptogenic Organizing Pneumonia/pathology
• Cryptogenic Organizing Pneumonia/physiopathology
• Diagnosis, Differential
• Glucocorticoids/therapeutic use
• Humans
• Lung/diagnostic imaging
• Lung/pathology
• Prognosis

The long-term effects of SARS-CoV-2 infection on pulmonary structure and function remain incompletely characterized.

To test whether SARS-CoV-2 infection leads to small airways disease in patients with persistent symptoms.

In this single-center study at a university teaching hospital, adults with confirmed COVID-19 who remained symptomatic more than 30 days following diagnosis were prospectively enrolled from June to December 2020 and compared with healthy participants (controls) prospectively enrolled from March to August 2018. Participants with post-acute sequelae of COVID-19 (PASC) were classified as ambulatory, hospitalized, or having required the intensive care unit (ICU) based on the highest level of care received during acute infection. Symptoms, pulmonary function tests, and chest CT images were collected. Quantitative CT analysis was performed using supervised machine learning to measure regional ground-glass opacity (GGO) and using inspiratory and expiratory image-matching to measure regional air trapping. Univariable analyses and multivariable linear regression were used to compare groups.

Overall, 100 participants with PASC (median age, 48 years; 66 women) were evaluated and compared with 106 matched healthy controls; 67% (67 of 100) of the participants with PASC were classified as ambulatory, 17% (17 of 100) were hospitalized, and 16% (16 of 100) required the ICU. In the hospitalized and ICU groups, the mean percentage of total lung classified as GGO was 13.2% and 28.7%, respectively, and was higher than that in the ambulatory group (3.7%, P < .001 for both comparisons). The mean percentage of total lung affected by air trapping was 25.4%, 34.6%, and 27.3% in the ambulatory, hospitalized, and ICU groups, respectively, and 7.2% in healthy controls (P < .001). Air trapping correlated with the residual volume–to–total lung capacity ratio (ρ = 0.6, P < .001).

In survivors of COVID-19, small airways disease occurred independently of initial infection severity. The long-term consequences are unknown.

© RSNA, 2022

Online supplemental material is available for this article.

See also the editorial by Elicker in this issue.

Cryptogenic organizing pneumonia (COP), formerly known as bronchiolitis obliterans organizing pneumonia, is an extremely rare disease in pregnancy. In this case, we report on COP diagnosed in recurrent pneumonia that does not respond to antibiotics in pregnant woman.

A 35-year-old woman with no prior lung disease presented with concerns of chest pain with cough, sputum, dyspnea, and mild fever at 11 wk’ gestation. She was diagnosed with community-acquired pneumonia and treated with antibiotics; her symptoms improved temporarily. Four weeks after discharge, she was re-admitted with aggravated symptoms. Chest computed tomography demonstrated multifocal patchy airspace consolidation and ground-glass opacities at the basal segments of the right lower lobe, at the lateral basal segment of the lower lobe, and at the lingular segment of the left upper lobe. Bronchoalveolar lavage revealed an increased lymphocyte count and a decreased CD4/CD8 ratio. Prednisolone (0.5 mg/kg/d) was administered for 10 d after the second admission. Dyspnea improved after 3 d of steroid treatment and other symptoms improved on the 5^th day of steroid administration. Post-delivery transbronchial lung biopsy further revealed the presence of granulation tissue with fibroblasts in small-bronchiole lumens.

This case suggests that it is important to differentiate COP from atypical pneumonia in the deteriorated condition despite antibiotic treatment.

• Antibiotics
• Bronchiolitis obliterans organizing pneumonia
• Corticosteroid
• Cryptogenic organizing pneumonia
• Pregnancy
• Case report

• Idiopathic interstitial pneumonia
• idiopathic pulmonary fibrosis
• interstitial lung disease
• nonspecific interstitial pneumonia
• organizing pneumonia
• usual interstitial pneumonia

• Checkpoint inhibitors
• Diffuse alveolar damage
• Hypersensitivity pneumonitis
• Immune-related adverse event
• Nonspecific interstitial pneumonia
• Organizing pneumonia
• Pneumonitis
• Thoracic imaging

• covid 19 pneumonitis
• high dependency unit
• hypoxemia
• infectious disease
• prednisolone
• pulmonary critical care
• steroids

• COVID-19
• Humans
• Oxygen
• Prednisolone/therapeutic use
• Respiratory Insufficiency/etiology
• Respiratory Insufficiency/therapy
• SARS-CoV-2

• Bronchiolitis Obliterans with Organizing Pneumonia
• cytomegalovirus (CMV) pneumonia
• kidney transplant recipient
• organizing pneumonia

• Bronchoalveolar lavage
• Cryptogenic organizing pneumonia
• Infection
• Organizing pneumonia
• Secondary organizing pneumonia

• History of medicine
• Idiopathic pulmonary fibrosis
• Interstitial lung disease

Cryptogenic organizing pneumonia (COP) is a type of idiopathic interstitial pneumonia with an acute or subacute clinical course. Bilateral lung consolidations located in the subpleural area and bronchovascular bundle are the most common findings on chest high-resolution computed tomography. The pathologic manifestations include granulation tissue in the alveoli, alveolar ducts, and bronchioles. COP responds fairly well to glucocorticoid monotherapy with rapid clinical improvement, but recurrence is common. However, treatment with combined immunosuppressant agents is not recommended, even if the COP patient does not respond to glucocorticoid monotherapy with expert opinion.

• Cryptogenic Organizing Pneumonia
• Glucocorticosteroid
• High-Resolution Computed Tomography

• Cryptogenic Organizing Pneumonia/diagnostic imaging
• Cryptogenic Organizing Pneumonia/etiology
• Humans
• Pneumonia/diagnostic imaging
• Pneumonia/etiology
• Tomography, X-Ray Computed

This review article aims to address mysteries existing between Interstitial Lung Abnormality (ILA) and Nonspecific Interstitial Pneumonia (NSIP). The concept and definition of ILA are based upon CT scans from multiple large-scale cohort studies, whereas the concept and definition of NSIP originally derived from pathology with evolution to multi-disciplinary diagnosis. NSIP is the diagnosis as Interstitial Lung Disease (ILD) with clinical significance, whereas only a part of subjects with ILA have clinically significant ILD. Eventually, both ILA and NSIP must be understood in the context of chronic fibrosing ILD and progressive ILD, which remains to be further investigated.

• AIP, acute interstitial pneumonia
• ATS/ERS, American Thoracic Society/European Respiratory Society
• BIP, bronchiolitis obliterans with interstitial pneumonia
• BOOP, bronchiolitis obliterans organizing pneumonia
• CT
• CTD, connective tissue disease
• Connective tissue disease (CTD)
• DIP, desquamative interstitial pneumonia
• GGO, ground-glass opacities
• GIP, giant cell interstitial pneumonia
• HRCT
• HRCT, high-resolution CT
• IIP, idiopathic interstitial pneumonia
• ILA, interstitial lung abnormality
• ILD, interstitial lung disease
• Interstitial lung abnormality (ILA)
• Interstitial lung disease (ILD)
• LIP, lymphoid interstitial pneumonia
• NSIP, nonspecific interstitial pneumonia
• Nonspecific interstitial pneumonia (NSIP)
• Pulmonary fibrosis
• RB-ILD, respiratory bronchiolitis-associated interstitial lung disease
• UIP, usual interstitial pneumonia
• fNSIP, fibrosing nonspecific interstitial pneumonia

Pulmonary infiltrates of variable etiology are one of the main reasons for hypoxemic respiratory failure leading to invasive mechanical ventilation. If pulmonary infiltrates remain unexplained or progress despite treatment, the histopathological result of a lung biopsy could have significant impact on change in therapy. Surgical lung biopsy is the commonly used technique, but due to its considerable morbidity and mortality, less invasive bronchoscopic transbronchial lung biopsy (TBLB) may be a valuable alternative.

Retrospective, monocentric, observational study in mechanically ventilated, critically ill patients, subjected to TBLB due to unexplained pulmonary infiltrates in the period January 2014 to July 2019. Patients’ medical records were reviewed to obtain data on baseline clinical characteristics, modality and adverse events (AE) of the TBLB, and impact of the histopathological results on treatment decisions. A multivariable binary logistic regression analysis was performed to identify predictors of AE and hospital mortality, and survival curves were generated using the Kaplan-Meier method.

Forty-two patients with in total 42 TBLB procedures after a median of 12 days of mechanical ventilation were analyzed, of which 16.7% were immunosuppressed, but there was no patient with prior lung transplantation. Diagnostic yield of TBLB was 88.1%, with AE occurring in 11.9% (most common pneumothorax and minor bleeding). 92.9% of the procedures were performed as a forceps biopsy, with organizing pneumonia (OP) as the most common histological diagnosis (54.8%). Variables independently associated with hospital mortality were age (odds ratio 1.070, 95%CI 1.006–1.138; p = 0.031) and the presence of OP (0.182, [0.036–0.926]; p = 0.040), the latter being confirmed in the survival analysis (log-rank p = 0.040). In contrast, a change in therapy based on histopathology alone occurred in 40.5%, and there was no evidence of improved survival in those patients.

Transbronchial lung biopsy remains a valuable alternative to surgical lung biopsy in mechanically ventilated critically ill patients. However, the high diagnostic yield must be weighed against potential adverse events and limited consequence of the histopathological result regarding treatment decisions in such patients.

• Critical illness
• Diagnostic yield
• Mechanical ventilation
• Organizing pneumonia
• Safety
• Transbronchial lung biopsy

To describe computed tomography (CT) findings of influenza H1N1 virus-associated pneumonia (IH1N1VAP), and to correlate CT findings to pathological ones.

The study included 24 patients with IH1N1VAP. Two observers independently evaluated the presence, distribution, and extent of CT findings. CT features were divided into either classical form (C-form) or non-classical form (NC-form). C-form included: A.) broncho-bronchiolitis and bronchopneumonia type, whereas NC-forms included: B.) diffuse peribronchovascular type, simulating subacute rheumatoid arthritis-associated (RA) interstitial lung disease (ILD) and C.) lower peripheral and/or peribronchovascular type, resembling dermatomyositis-associated ILD and COVID-19 pneumonia. In 10 cases with IH1N1VAP where lung biopsy was performed, CT and pathology findings were correlated.

The most common CT findings were ground-glass opacities (24/24, 100 %) and airspace consolidation (23/24, 96 %). C-form was found in 11 (46 %) patients while NC-form in 13 (54 %). Types A, B, and C were seen in 11(46 %), 4 (17 %), and 9 (38 %) patients, respectively. The lung biopsy revealed organizing pneumonia in all patients and 6 patients (60 %) showed incorporated type organizing pneumonia that was common histological findings of rapidly progressive ILD.

In almost half of patients of IH1N1VAP, CT images show NC-form pneumonia pattern resembling either acute or subacute RA or dermatomyositis-associated ILD and COVID-19 pneumonia.

• COVID-19
• Computed tomography
• Influenza A (H1N1) virus
• Myositis and muscle disease
• Pneumonia
• Rheumatoid arthritis

• Acute antibody-mediated rejection
• Acute cellular rejection
• Alveolar fibroelastosis
• Chronic lung allograft dysfunction
• Lung transplant

• Graft Rejection/immunology
• Graft Rejection/pathology
• Humans
• Lung/immunology
• Lung/pathology
• Lung/surgery
• Lung Transplantation/adverse effects

• chest radiography
• computed tomography
• coronavirus disease 2019
• coronavirus pneumonia
• diagnosis
• polymerase chain reaction

• COVID-19/diagnosis
• COVID-19 Nucleic Acid Testing
• COVID-19 Serological Testing
• Data Accuracy
• Humans
• Thorax/diagnostic imaging
• Tomography, X-Ray Computed

• 31570775 National Natural Science Foundation of China
• 81772705 National Natural Science Foundation of China
• 81972393 National Natural Science Foundation of China
• National Natural Science Foundation of China

• Bronchiolitis obliterans organizing pneumonia
• glucocorticoid
• high resolution computer tomography
• systemic lupus erythematosus
• transbronchial lung biopsy

Secondary organizing pneumonia (SOP) is difficult to distinguish from cryptogenic organizing pneumonia (COP) considering various clinical situations. SOP caused by Mycobacterium tuberculosis is rare; indeed, it has not been reported as a sequela of disseminated tuberculosis.

From January 2016 to December 2018, we identified six cases of tuberculosis-associated SOP in which Mycobacterium tuberculosis was revealed by microbiological examination; one of the cases was miliary tuberculosis.

Of the six cases, 17% were positive for acid fast bacillus (AFB) stain, but 100% were positive for M. tuberculosis polymerase chain reaction (MTB PCR) and AFB culture. In all cases, transbronchial lung biopsy was performed and organizing pneumonia was confirmed pathologically. All survived after treatment with anti-tuberculosis therapy.

Pulmonary tuberculosis, which shows OP in lung biopsy, is diagnosed through MTB PCR and AFB culture, and the prognosis is thought to be good.

• Organizing pneumonia
• Transbronchial lung biopsy
• Tuberculosis

Cryptogenic organizing pneumonia (COP) is characterized by good response to corticosteroids, but frequent relapses after reduction or cessation of treatment are noted. The incidence, risk factors of relapse, and long-term outcomes of patients with COP remain undetermined. Patients with COP from September 2010 to December 2017 were enrolled. Hospital and office records were used as data sources. Clinical information, lab examinations, chest radiographs, treatment courses, and follow-up data were collected. Relapse group was defined as worsening of clinical manifestations in combination with progression of radiographic abnormalities in the absence of identified causes. Eighty-seven patients with COP were enrolled. Of them, 73 patients were treated with corticosteroids with relapse rate yielding 31.5% (23 of 73). Eleven patients were treated with macrolides and none of them relapsed. Fever was more common (65.2% vs. 32.0%, p = 0.004), C-reactive protein (CRP) was higher (31.5 ± 39.4 mg/L vs. 17.5 ± 32.2 mg/L, p = 0.038), and diffusion capacity for carbon monoxide (DLCO) % predicted was lower (45.9 ± 14.2% vs. 57.6 ± 18.5%, p = 0.050) in relapse group compared to nonrelapse group. Four patients who presented with organizing pneumonia (OP) as the first manifestation were ultimately diagnosed with OP secondary to autoimmune disease in follow-up. We showed relapse was common in COP patients treated with corticosteroids, but the prognosis was favorable. Fever, elevated CRP, and a reduced DLCO were related to relapse. As OP may not always be cryptogenic, a careful follow-up should be programmed to diagnose the underlying systemic disease.

• Cryptogenic organizing pneumonia
• corticosteroids
• outcome
• relapse
• risk factor

• Chest radiography
• Computed tomography
• Coronavirus disease 2019
• Coronavirus pneumonia
• Diagnosis
• Polymerase chain reaction

• Betacoronavirus/genetics
• Betacoronavirus/immunology
• Betacoronavirus/isolation & purification
• COVID-19
• Clinical Laboratory Techniques/methods
• Coronavirus/genetics
• Coronavirus/immunology
• Coronavirus/isolation & purification
• Coronavirus Infections/diagnosis
• Coronavirus Infections/epidemiology
• Coronavirus Infections/virology
• Humans
• Pandemics/prevention & control
• Pneumonia, Viral/diagnosis
• Pneumonia, Viral/epidemiology
• Pneumonia, Viral/virology
• Radiography
• Real-Time Polymerase Chain Reaction
• SARS-CoV-2
• Thorax/diagnostic imaging
• Tomography, X-Ray Computed

• Aspiration
• DIPNECH
• bronchiole
• bronchiolitis
• diacetyl
• inhalational injury
• small airways
• smoking
• vaping
• virus

The disease concept of interstitial lung disease with idiopathic pulmonary fibrosis at its core has been relied on for many years depending on morphological classification. The separation of non-specific interstitial pneumonia with a relatively good prognosis from usual interstitial pneumonia is also based on the perception that morphology enables predict the prognosis. Beginning with dust-exposed lungs, initially, interstitial pneumonia is classified by anatomical pathology. Diagnostic imaging has dramatically improved the diagnostic technology for surviving patients through the introduction of high-resolution computed tomography scan. And now, with the introduction of therapeutics, the direction of diagnosis is turning. It can be broadly classified into to make known the importance of early diagnosis, and to understand the importance of predicting the speed of progression/deterioration of pathological conditions. For this reason, the insight of “early lesions” has been discussed. There are reports that the presence or absence of interstitial lung abnormalities affects the prognosis. Searching for a biomarker is another prognostic indicator search. However, as is the case with many chronic diseases, pathological conditions that progress linearly are extremely rare. Rather, it progresses while changing in response to environmental factors. In interstitial lung disease, deterioration of respiratory functions most closely reflect prognosis. Treatment is determined by combining dynamic indicators as faithful indicators of restrictive impairments. Reconsidering the history being classified under the disease concept, the need to reorganize treatment targets based on common pathological phenotype is under discussed. What is the disease concept? That aspect changes with the discussion of improving prognosis.

• Interstitial Pneumonia
• Pathological Phenotype
• Progressive Fibrosis
• Idiopathic Pulmonary Fibrosis

• cryptogenic organizing pneumonia
• interstitial
• lung diseases
• multidetector computed tomography
• organizing pneumonia

• Connective tissue disease
• Cryptogenic organizing pneumonia
• Multidetector computed tomography
• Treatment outcome

• Checkpoint inhibitors
• Diffuse alveolar damage
• Hypersensitivity pneumonitis
• Immune-related adverse event
• Nonspecific interstitial pneumonia
• Organizing pneumonia
• Pneumonitis
• Thoracic imaging

• Humans
• Immunotherapy/adverse effects
• Incidence
• Neoplasms/immunology
• Neoplasms/therapy
• Pneumonia/chemically induced
• Pneumonia/epidemiology
• Pneumonia/immunology
• Pneumonia/therapy

Lung injury can occur secondary to a myriad of causes, including infection, immunologic disorders, drug toxicity, or inhalational injury among others. Although the list of causative agents is long, the lung’s response to injury is limited resulting in similar patterns of disease irrespective of the cause. From a pathological perspective, acute lung injury refers to a group of entities that present with acute or subacute disease. These conditions are characterized by particular histological patterns including diffuse alveolar damage, acute fibrinous and organizing pneumonia, organizing pneumonia, and eosinophilic pneumonia and clinically correspond to the varying degrees of acute respiratory distress syndrome (Patel et al, Chest 125:197–202, 2004; Beasley et al, Arch Pathol Lab Med 126:1064–1070, 2002; Avecillas et al, Clin Chest Med 27:549–557, 2006; Cottin, Cordier, Semin Respir Crit Care Med 33:462–475, 2012; Ferguson et al, Intensive Care Med 38:1573–1582, 2012). In most cases, the underlying cause will not be apparent from the histological findings requiring close correlation with clinical history and laboratory findings to determine the etiology. Nevertheless, careful search for infectious organisms with application of histochemical and immunohistochemical stains should be performed in all cases in order to identify cases that benefit from more targeted treatment.