Cryptogenic Organizing Pneumonia (COP) Cryptogenic Organizing Pneumonia Overview: • Idiopathic form of organizing pneumonia • formerly BOOP • Type of interstitial lung that affects the distal bronchioles, alveolar ducts and walls. • Secondary OP can be seen in association with CTD, drugs, malignancy and other interstitial pneumonias Cryptogenic Organizing Pneumonia Epidemiology: • Unknown • 6-7 cases per 100,000 hospital admissions • 56% of OP considered cryptogenic Cryptogenic Organizing Pneumonia - Clinical manifestations: • Onset: 5-6th decades of life • History: cough, dyspnea, fever, malaise, weight loss of > 10 pounds • Hemoptysis - rare Cryptogenic Organizing Pneumonia - Imaging: • CXR: Peripheral distribution of opacities, Unilateral consolidation and GG pattern, irregular lines, nodular opacities. Rare: pleural effusions, pleural thickening, cavities • HRCT: patchy consolidation: peripheries and lower lung zone, GGO, small modular opacities, bronchial wall thickening with dilatation Cryptogenic Organizing Pneumonia - Diagnosis: • Lung biopsy: TBNA or Surgical lung biopsy • Histopathology: Intraluminal plugs of inflammatory debris-small airways, alveolar ducts and adiacent alveoli • Absence of histopathology suggestive of other processes Workup / Laboratory Studies: - No specific lab studies - Make sure to order: • CBC with diff • Chem • Transaminases • UA • Pneumonia: blood culture, sputum culture, urinary studies legionella/strep, HIV • CTD workup: ANA, RF, CCP, CPK, anti-scl70, anticentromere ab, Anti-dsDNA, ANCA COP DDX: • CAP, Idiopathic interstitial pneumonia’s, Hypersensitivity pneumonitis, Granulomatous organizing pneumonia, Chronic eosinophilia pneumonia, Pulmonary lymphoma, Diffuse alveolar damage Cryptogenic Organizing Pneumonia Treatment: • Mild: observation • Moderate: oral glucocorticoids • Severe/ failure steroids: Cytotoxic Therapy - Dr. Ravi Singh @rav7ks #Cryptogenic #Organizing #Pneumonia #COP #BOOP #pulmonary #ILD #diagnosis #management
