or its histological variant, acute fibrinous and organizing pneumonia, which are both well-known complications of viral infections. It was identified in 1985, although its symptoms had been noted before but not recognised as a separate lung disease. The risk of COP is higher for people with inflammatory diseases like lupus, dermatomyositis, rheumatoid arthritis, and scleroderma. It most commonly presents in the 5th or 6th decade of life and it is exceedingly rare in children. Pathophysiology Organizing pneumonia is usually preceded by some type of lung injury that causes a localized denudation or disruption in continuity of the epithelial basal laminae of the type 1 alveolar pneumocytes that line the alveoli. This injury to the epithelial basal lamina results in inflammatory cells and plasma proteins leaking into the alveolar space and forming fibrin, resulting in an initial fibroblast driven intra-alveolar fibroproliferation. The fibroblasts differentiate into myofibroblasts and continue to form fibrosis resulting in intra-alveolar fibroinflammatory buds (Masson's Bodies) that are characteristic of organizing pneumonia. These Masson's bodies consist of inflammatory cells contained in an extracellular matrix consisting of type I collagen, fibronectin, procollagen type III, tenascin C and proteoglycans. Angiogenesis , or the formation of blood vessels, occurs in the Masson's bodies and this is driven by vascular endothelial growth factor. Remodeling occurs, resulting in the intra-alveolar fibroinflammatory buds (Masson's Bodies) moving into the interstitial space and forming collagen globules that are then covered by type 1 alveolar epithelial cells with well developed basement membranes. These type 1 alveolar epithelial cells (pneumocytes) then proliferate, restoring the continuity and function of the alveolar unit. This process is in contrast to the histopathologic changes seen in usual interstitial pneumonia where extensive fibrosis and inflammation occur leading to fibroblastic foci to form in the alveolar spaces resulting in obliteration of the alveolar space, scarring and significant damage to lung architecture (the alveoli). Tissue inhibitors of metalloproteinases (which inhibit breakdown of the extracellular matrix connective tissue) are more active in usual interstitial pneumonia as compared to organizing pneumonia, this is thought to lead to a greater deposition of connective tissue in the alveolar space in interstitial pneumonia as compared to organizing pneumonia and may explain the progressive, irreversible fibrosis seen in usual interstitial pneumonia. Gelatinolytic activity (resulting in the breakdown of extracellular matrix connective tissue) is greater in organizing pneumonia as compared to usual interstitial pneumonia, and this is thought to contribute to the reversible