Skip to main content

Advertisement

Log in

Organizing pneumonia: a kaleidoscope of concepts and morphologies

  • Chest
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

The basic histopathological pattern of organizing pneumonia (OP) is well recognized, but the contexts in which it is encountered continue to increase. In parallel with an appreciation of new causes and associations of OP, an understanding of OP in the spectrum of lung injury and repair has evolved. There is an increasing array of HRCT manifestations of OP, some of which have only recently been described. This article concentrates on new concepts surrounding OP and highlights newly described imaging patterns.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10

Similar content being viewed by others

References

  1. Charcot JM (1878) Des pneumonies chroniques. Rev Mensuelle Med Chir 2:776–790

    Google Scholar 

  2. Tripier R (1904) Traité d’anatomie pathologique général. Masson, Paris

    Google Scholar 

  3. Milne LS (1911) Chronic pneumonia (including a discussion of two cases of syphilis of the lung). Am J Med Sci 142:408–438

    Article  Google Scholar 

  4. Floyd R (1922) Organization of pneumonic exudates. Am J Med Sci 163:527–548

    Article  Google Scholar 

  5. Basset F, Ferrans VJ, Soler P, Takemura T, Fukaoa Y, Crystal RG (1986) Intraluminal fibrosis in interstitial lung disorders. Am J Pathol 122:443–461

    PubMed  CAS  Google Scholar 

  6. Fukuda Y, Ferrans VJ, Schoenberger CI, Rennard SI, Crystal RG (1985) Patterns of pulmonary structural remodeling after experimental paraquat toxicity. Am J Pathol 118:452–475

    PubMed  CAS  Google Scholar 

  7. Nozawa Y (1972) Histopathological findings of the lung in collagen diseases especially on their differential diagnosis. Acta Pathol Jap 22:843–858

    CAS  Google Scholar 

  8. Davison AG, Heard BE, McAllister WA, Turner-Warwick ME (1983) Cryptogenic organizing pneumonitis. Q J Med 52:382–394

    PubMed  CAS  Google Scholar 

  9. Epler GR, Colby TV, McLoud TC, Carrington CB, Gaensler EA (1985) Bronchiolitis obliterans organizing pneumonia. N Eng J Med 17:152–158

    Article  Google Scholar 

  10. Geddes DM (1991) BOOP and COP. Thorax 46:545–547

    Article  PubMed  CAS  Google Scholar 

  11. Oikonomou A, Hansell DM (2002) Organizing pneumonia: the many morphological faces. Eur Radiol 12:1486–1496

    Article  PubMed  Google Scholar 

  12. Hansell DM (1992) What are bronchiolitis obliterans organizing pneumonia (BOOP) and cryptogenic organizing pneumonia (COP)? Clin Radiol 45:369–370

    Article  PubMed  CAS  Google Scholar 

  13. Epler GR (1992) Bronchiolitis obliterans organizing pneumonia definition and clinical features. Chest Suppl 102:2–6

    Google Scholar 

  14. Izumi T (1992) Congress summary. Chest Suppl 102:50

    Article  Google Scholar 

  15. Katzenstein A-LA, Myers JL (1998) Idiopathic pulmonary fibrosis clinical relevance of pathologic classification. Am J Respir Crit Care Med 157:1301–1315

    PubMed  CAS  Google Scholar 

  16. American Thoracic Society/European Respiratory Society (2002) International Multidisciplinary Consensus Classification of the Idiopathic Interstitial Pneumonias. Am J Respir Crit Care Med 165:277–304

    Google Scholar 

  17. Masson P, Riopelle JL, Martin P (1937) Poumon rheumatismal. Ann Anat Pathol 14:359–382

    Google Scholar 

  18. Cordier J-F (2006) Cryptogenic organizing pneumonia. Eur Respir J 28:422–446

    Article  PubMed  Google Scholar 

  19. Lappi-Blanco E, Kaarteenaho-Wiik R, Soini Y, Risteli J, Paakko P (1999) Intraluminal fibromyxoid lesions in bronchiolitis obliterans organizing pneumonia are highly capillarized. Human Pathol 30:1192–1196

    Article  CAS  Google Scholar 

  20. Peyrol S, Cordier JF, Grimaud JA (1990) Intra-alveolar fibrosis of idiopathic bronchiolitis obliterans-organizing pneumonia. Cell-matrix patterns. Am J Pathol 137:155–170

    PubMed  CAS  Google Scholar 

  21. Takiya C, Peyrol S, Cordier JF, Grimaud JA (1983) Connective matrix organization in human pulmonary fibrosis. Collagen polymorphism analysis in fibrotic deposit by immunohistiological methods. Virchows Arch 44:223–240

    Article  CAS  Google Scholar 

  22. Kuhn C, Mason RJ, Boldt J, King TE, Crouch E, Varitov T, McDonald JA (1989) An immunohistiochemical study of architectural remodeling and connective tissue synthesis in pulmonary fibrosis. Am Rev Respir Dis 140:1693–1703

    Article  PubMed  Google Scholar 

  23. Gudmundsson G, Sveinsson O, Isaksson HJ, Jonsson S, Frodadottir H, Aspelund T (2006) Epidemiology of organizing pneumonia in Iceland. Thorax 61:805–808

    Article  PubMed  CAS  Google Scholar 

  24. King TE Jr, Mortenson RL (1992) Cryptogenic organizing pneumonitis. The North American experience. Chest Suppl 102:8–13

    Google Scholar 

  25. Izumi T, Kitaichi M, Nishimura K, Nagai S (1992) Bronchiolitis obliterans organizing pneumonia. Clinical features and differential diagnosis. Chest 102:715–719

    Article  PubMed  CAS  Google Scholar 

  26. Spiteri MA, Klernerman P, Sheppard MN, Padley S, Clark TJ, Newman-Taylor A (1992) Seasonal cryptogenic organising penumonia with biochemical cholestasis: a new clinical entity. Lancet 340:281–284

    Article  PubMed  CAS  Google Scholar 

  27. Cordier JF, Loire R, Brune J (1989) Idiopathic bronchiolitis obliterans organizing pneumonia. Definition of characteristic clinical profiles in a series of 16 patients. Chest 96:999–1004

    Article  PubMed  CAS  Google Scholar 

  28. Lazor R, Vandevenne A, Pelletier A, Leclerc P, Court-Fortune I, Cordier JF (2000) Cryptogenic organizing pneumonia. Characteristics of relapses in a series of 48 patients. Am J Respir Crit Care Med 162:571–577

    PubMed  CAS  Google Scholar 

  29. Lohr RH, Boland BJ, Douglas WW, Dockrell DH, Colby TV, Swensen SJ, Wollan PC, Silverstein MD (1997) Organizing pneumonia. Features and prognosis of cryptogenic, secondary and focal variants. Arch Intern Med 157(12):1323–1329

    Article  PubMed  CAS  Google Scholar 

  30. Müller NL, Staples CA, Miller RR (1990) Bronchiolitis obliterans organizing pneumonia: CT features in 14 patients. Am J Roentgenol 154:983–987

    Google Scholar 

  31. Lee KS, Kullnig P, Hartman TE, Müller NL (1994) Cryptogenic organizing pneumonia: CT findings in 43 patients. Am J Roentgenol 162:543–546

    CAS  Google Scholar 

  32. Souza CA, Müller NL, Lee KS et al (2006) Idiopathic interstitial pneumonias: prevalence of mediastinal lymph node enlargement in 206 patients. AJR Am J Roentgenol 186:995–999

    Article  PubMed  Google Scholar 

  33. Haddock JA, Hansell DM (1992) The radiology and terminology of cryptogenic organizing pneumonia. Br J Radiol 65:674–680

    Article  PubMed  CAS  Google Scholar 

  34. Ujita M, Renzoni ES, Veeraraghavan S, Wells AU, Hansell DM (2004) Organizing pnemonia: Perilobular pattern at thin-section CT. Radiology 232:757–761

    Article  PubMed  Google Scholar 

  35. Johkoh T, Müller NL, Cartier Y, Kavanagh PV, Hartman TE, Akira M, Ichikado K, Ando M, Nakamura H (1999) Idiopathic interstitial peumonias: diagnostic accuracy of thin-section CT in 129 patients. Radiology 211:555–560

    PubMed  CAS  Google Scholar 

  36. Asad S, Aquino SL, Piyavisetpat N, Fischman AJ (2004) False-positive FDG positron emission tomography. Uptake in nonmalignant chest abnormalities. Radiology 182:983–989

    Google Scholar 

  37. Domingo JA, Perez-Calvo JI, Carretero JA, Ferrando J, Cay A, Civeira F (1993) Bronchiolitis obliterans organizing pneumonia. An unusual cause of solitary pulmonary nodule. Chest 103:1621–1623

    Article  PubMed  CAS  Google Scholar 

  38. Hashemzadeh A, Clavel M, Musso C, Touraine F, Paraf F, Bonnaud F (2001) Pseudoneoplastic forms of bronchiolitis obliterans with organizing pneumopathy (BOOP). Rev Mal Respir 18:205–208

    PubMed  CAS  Google Scholar 

  39. Astudillo L, Martin-Blondel G, Sans N, Dhaste G, Couret B, Arlet-Suau E (2004) Solitary nodular form of bronchiolitis obliterans organizing pneumonia. Am J Med 117:887–888

    Article  PubMed  Google Scholar 

  40. Nishimura K, Itoh H (1992) High-resolution computed tomographic features of bronchiolitis obliterans organizing pneumonia. Chest Suppl 102:26–31

    Google Scholar 

  41. Arakawa H, Kurihara Y, Niimi H, Nakajima Y, Johkoh T, Nakamura H (2001) Bronchiolitis obliterans with organizing pneumonia versus chronic eosinophilic pneumonia: high-resolution CT findings in 81 patients. Am J Roentgenol 176:1053–1058

    CAS  Google Scholar 

  42. Gruden JF, Webb WR, Warnockv M (1994) Centrilobar opacities in the lung on high-resolution CT: diagnsotic considerations and pathologic correlation. Am J Roentgenol 162:569–574

    CAS  Google Scholar 

  43. Müller NL, Miller R (1995) Diseases of the bronchioles: CT and histopathologic findings. Radiology 196:3–12

    PubMed  Google Scholar 

  44. Akira M, Yamamoto S, Sakatani M (1998) Bronchiolitis obliterans orga- nizing pneumonia manifesting as multiple large nodules or masses. Am J Roentgenol 170:291–295

    CAS  Google Scholar 

  45. Orseck MJ, Player KC, Woollen CD, Kelley H, White PF (2000) Bronchiolitis obliterans organizing pneumonia mimicking multiple pulmonary metastases. Am Surg 66:11–13

    PubMed  CAS  Google Scholar 

  46. Forghieri F, Potenza L, Morselli M, Maccaferri M, Pedrazzi L, Barozzi P, Vallerini D, Riva G, Zanetti E, Quadrelli C, Rossi G, Rivasi F, Messino M, Rumpianesi F, Grottola A, Venturelli C, Pecorari M, Codeluppi M, Torelli G, Luppi M (2010) Organising pneumonia mimicking invasive fungal disease in patients with leukaemia. Eur J Haem 85:76–82

    Google Scholar 

  47. Murata K, Khan A, Herman PG (1989) Pulmonary parenchymal disease: evaluation with high-resolution CT. Radiology 170:629–635

    PubMed  CAS  Google Scholar 

  48. Johkoh T, Muller NL, Ichikado K, Nakamura H, Itoh H, Nagareda T (1999) Perilobular pulmonary opacities: high-resolution CT findings and pathologic correlation. J Thorac Imaging 14:172–177

    Article  PubMed  CAS  Google Scholar 

  49. Murphy JM, Schnyder P, Verschakelen J, Leuenberger P, Flower CD (1999) Linear opacities on HRCT in bronchiolitis obliterans organising pneumonia. Eur Radiol 9:1813–1817

    Article  PubMed  CAS  Google Scholar 

  50. Voloudaki AE, Bouros DE, Froudarakis ME, Datseris GE, Apostolaki EG, Gourtsoyiannis NC (1996) Crescentic and ring-shaped opacities. CT features in two cases of bronchiolitis obliterans organizing pneumonia (BOOP). Acta Radiol 37:889–892

    Article  PubMed  CAS  Google Scholar 

  51. Kim SJ, Lee KS, Ryu YH, Yoon YC, Choe KO, Kim TS, Sung KJ (2003) Reversed halo sign on high-resolution CT of cryptogenic organizing pneumonia: diagnostic implications. Am J Roentgenol 180:1251–1254

    Google Scholar 

  52. Zompatori M, Poletti V, Battista G, Diegoli M (1999) Bronchiolitis obliterans with organizing pneumonia (BOOP), presenting as a ring-shaped opacity at HRCT (the atoll sign). A case report Radiol Med vol 97:308–310

    CAS  Google Scholar 

  53. Marlow TJ, Krapiva PI, Schabel SI, Judson MA (1999) The “fairy ring”: a new radiographic finding in sarcoidosis. Chest 115:275–276

    Article  PubMed  CAS  Google Scholar 

  54. Agarwal R, Aggarwal AN, Gupta D (2007) Another cause of reverse halo sign: Wegener’s granulomatosis. Br J Radiol 80:849–850

    Article  PubMed  CAS  Google Scholar 

  55. Gaeta M, Blandino A, Scribano E, Minutoli F, Volta S, Pandolfo I (1999) Computed tomography halo sign in pulmonary nodules: frequency and diagnostic value. J Thorac Imaging 14:109–113

    Article  PubMed  CAS  Google Scholar 

  56. Rossi SE, Erasmus JJ, Volpacchio M, Franquet T, Castiglioi T, McAdams HP (2003) “Crazy-paving“pattern at thin-section CT of the lungs: radiologic-pathologic overview. Radiograph 23:1509–1519

    Article  Google Scholar 

  57. Gómez-Gómez A, Martínez-Martínez R, Gotway MB (2011) Organizing Pneumonia Associated With Swine-Origin Influenza A H1N1 2009 Viral Infection. Am J Roentgenol 196:103–104

    Article  Google Scholar 

  58. Myers JL, Limper AH, Swensen SJ (2003) Drug-induced lung disease: a pragmatic classification incorporating HRCT appearances. Semin Respir Crit Care Med 24:445–453

    Article  PubMed  Google Scholar 

  59. Cameron RJ, Kolbe J, Wilsher ML, Lambie N (2000) Bronchiolitis obliterans organizing pneumonia associated with the use of nitrofurantoin. Thorax 55:249–251

    Article  PubMed  CAS  Google Scholar 

  60. Romero S, Barroso E, Rodriguez-Paniagua M, Aranda FI (2002) Organizing pneumonia adjacent to lung cancer: frequency and clinicopathologic features. Lung Cancer 35:195–201

    Article  PubMed  Google Scholar 

  61. Song J, Gorgan L, Corkey R, Kwa SL (2004) An unusual case of bronchiolitis obliterans organizing pneumonia concomitant with bronchioloalveolar carcinoma. Respiration 71:95–97

    Article  PubMed  Google Scholar 

  62. Uner AH, Rozum-Slota B, Katzenstein A-LA (1996) Bronchiolitis obliterans-organizing Pneumonia (BOOP)-like variant of Wegener’s granulomatosis: A clinicopathologic study of 16 Cases. Am J Surg pathol 20:794–801

    Article  PubMed  CAS  Google Scholar 

  63. Miyazaki Y, Tateishi T, Akashi T, Ohtani Y, Inase N, Yoshizawa N (2008) Clinical predictors and histologic appearance of acute exacerbations in chronic hypersensitivity pneumonitis. Chest 134:1265–1270

    Article  PubMed  Google Scholar 

  64. Crestani B, Valeyre D, Roden S, Wallaert B, Dalphin JC, Cordier JF (1998) Bronchiolitis obliterans organizing pneumonia syndrome primed by radiation therapy to the breast. Am J Respir Crit Care Med 158:1929–1935

    PubMed  CAS  Google Scholar 

  65. Arbetter KR, Prakash UB, Tazelaar HD, Douglas WW (1999) Radiation- induced pneumonitis in the “nonirradiated” lung. Mayo Clin Proc 74:27–36

    Article  PubMed  CAS  Google Scholar 

  66. London L, Majeski EI, Altman-Hamamdzic S, Enockson C, Paintlia MK, Harley RA, London SD (2002) Respiratory reovirus 1/L induction of diffuse alveolar damage: pulmonary fibrosis is not modulated by corticosteroids in acute respiratory distress syndrome in mice. Clin Immunol 103:284–295

    Article  PubMed  CAS  Google Scholar 

  67. Mandal RV, Mark EJ, Kradin RL (2008) Organizing pneumonia and pulmonary lymphatic architecture in diffuse alveolar damage. 39:1234–8

  68. Majeski EI, Harley RA, Bellum SC, London SD, London L (2003) Differential role for T cells in the development of fibrotic lesions associated with reovirus 1/L-induced bronchiolitis obliterans organizing pneumonia versus acute respiratory distress syndrome. Am J Respir Cell Mol Biol 28:208–217

    Article  PubMed  CAS  Google Scholar 

  69. Collard HR, Moore BB, Flaherty KR, Brown KK, Kaner RJ, King TE Jr, Lasky JA, Loyd JE, Noth I, Olman MA, Raghu G, Roman J, Ryu JH, Zisman DA, Hunninghake GW, Colby TV, Egan JJ, Hansell DM, Johkoh T, Kaminski N, Kim DS, Kondoh Y, Lynch DA, Müller-Quernheim J, Myers JL, Nicholson AG, Selman M, Toews GB, Wells AU, Martinez FJ, The Idiopathic Pulmonary Fibrosis Clinical Research Network Investigators (2007) Acute Exacerbations of Idiopathic Pulmonary Fibrosis. Am J Respir Crit Care Med 176:636–643

    Article  PubMed  Google Scholar 

  70. Churg A, Müller NL, Silva CIS, Wright JL (2007) Acute Exacerbation (Acute Lung Injury of Unknown Cause) in UIP and Other Forms of Fibrotic Interstitial Pneumonias. Am J Surg Pathol 31:277–284

    Article  PubMed  Google Scholar 

  71. Kondoh Y, Taniguchi H, Kataoka K, Suzuki R, Ogura T, Jokho T, Yokoi T, Wells AU, Kitaichi M (2010) Prognostic factors in rapidly progressive interstitial pneumonia. Respirology 15:257–264

    Article  PubMed  Google Scholar 

  72. Nizami IY, Kissner DG, Visscher DW, Dubaybo BA (1995) Idiopathic bronchiolitis obliterans with organizing pneumonia. An acute and life-threatening syndrome. Chest 108:271–277

    Article  PubMed  CAS  Google Scholar 

  73. Beasley MB, Franks TJ, Galvin JR, Gochuico B, Travis WD (2002) Acute fibrinous and organizing pneumonia: a histological pattern of lung injury and possible variant of diffuse alveolar damage. Arch Pathol Lab Med 126:1064–1070

    PubMed  Google Scholar 

  74. Gosink BB, Friedman PJ, Liebow AA (1973) Bronchiolitis obliterans. Roentgenologic–pathologic correlation. Am J Roentgenol Radium Ther Nucl Med 117:816–832

    PubMed  CAS  Google Scholar 

  75. Cohen AJ, King TE Jr, Downey GP (1994) Rapidly progressive bronchiolitis obliterans with organizing pneumonia. Am J Respir Crit Care Med 149:1670–1675

    PubMed  CAS  Google Scholar 

  76. Lee JS, Lynch DA, Sharma S, Brown KK, Müller NL (2003) Organizing pneumonia: prognostic implication of high-resolution computed tomography features. J Comput Assist Tomogr 27:260–265

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to David M. Hansell.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Roberton, B.J., Hansell, D.M. Organizing pneumonia: a kaleidoscope of concepts and morphologies. Eur Radiol 21, 2244–2254 (2011). https://doi.org/10.1007/s00330-011-2191-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-011-2191-6

Keywords

Navigation