PMC2647170_01
Diffuse nodular pattern of cryptogenic organizing pneumonia in leukemic patient in 49-year-old female.. Posteroanterior chest radiograph (A) showing diffuse nodular opacities scattered throughout both lungs. Axial CT (B) and reformatted coronal (C) images of lung show numerous 1-mm to 5-mm nodules (arrow) in diffuse distribution and along bronchovascular structure. Patchy infiltration is also present in left lower lobe. Pathological examination of lung biopsy specimen (D) (Hematoxylin & Eosin staining, x200) shows aggregates of fibrous plugs within small airways and alveoli around interstitial inflammation, consistent with cryptogenic organizing pneumonia. (E) Parenchymal nodules show localized areas of organizing pneumonia (open arrow) surrounding bronchiolitis obliterans (black arrow) that are separated from other involved areas by zone of relative normal parenchyma (Hematoxylin & Eosin staining, x40). Two weeks after steroid treatment, chest radiograph (F) shows only few small patchy and nodular opacities in both lungs. Three weeks later, chest radiograph (G) shows almost complete resolution except for linear opacities in right lower lung.
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F1
On day 11, chest radiograph demonstrated a bilateral and symmetrical distribution of multiple pulmonary nodules (Fig. 1A). Twenty hours later, a chest computed tomography (CT) scan confirmed the presence of numerous discrete 1-mm to 5-mm nodules throughout the lungs (Fig. 1B, C). Histopathological analysis revealed that polypoid granulation tissue was filling the air spaces and foamy macrophages and inflammatory cells with interstitial pneumonia and air-space fibrosis were present, consistent with COP (Fig. 1D, E). Dramatic improvement of the clinical symptoms and radiographic abnormalities was noted after two weeks of appropriate steroid treatment (Fig. 1F), and the lesions were almost completely resolved after three weeks (Fig. 1G).