fibroproliferation characteristic of organizing pneumonia. Diagnosis On clinical examination, crackles are common, and more rarely, patients may have clubbing (<5% of cases). Laboratory findings are nonspecific but inflammatory markers such as the erythrocyte sedimentation rate or C-reactive protein and the lymphocyte count are frequently elevated. If the organizing pneumonia is secondary to a connective tissue disorder, then the associated laboratory values such as the anti-nuclear antibody, rheumatoid factor, anti-citrullinated protein antibodies, anti-dsDNA antibodies and other similar connective tissue associated antibodies are elevated. Pulmonary function testing in people with organizing pneumonia, either cryptogenic or due to secondary causes, shows a restrictive defect with a decrease in the gas absorptive capacity of the lungs (seen as a decrease in the diffusion capacity of carbon monoxide). Airflow obstruction is usually not seen on pulmonary function testing. Bronchoscopy with bronchoalveolar lavage is recommended in possible cases of organizing pneumonia to rule out infection and other causes of alveolar infiltrates. The bronchoalveolar lavage in organizing pneumonia shows a lymphocytic predominant inflammation of the alveoli with increases in neutrophils and eosinophils. Resolution of inflammatory cells in the bronchoalveolar lavage is usually delayed in organizing pneumonia, lagging behind clinical and radiographic improvement. Biopsy findings in patients with organizing pneumonia consist of loose connective tissue plugs involving the alveoli, alveolar ducts and bronchioles. The loose connective tissue plugs occupying the alveolar spaces often connect to other connective tissue plugs in nearby alveoli via the pores of Kohn creating a characteristic butterfly pattern on histology. There is usually minimal to no interstitial inflammatory changes in biopsies of organizing pneumonia. Imaging The chest x-ray is distinctive with features that appear similar to an extensive pneumonia, with both lungs showing widespread white patches. The white patches may seem to migrate from one area of the lung to another as the disease persists or progresses. Computed tomography (CT) may be used to confirm the diagnosis. Often the findings are typical enough to allow the doctor to make a diagnosis without ordering additional tests. To confirm the diagnosis, a doctor may perform a lung biopsy using a bronchoscope. Many times, a larger specimen is needed and must be removed surgically. 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 high resolution computed tomography, airspace consolidation with air bronchograms is present in more