Differential diagnosis of bronchiolitis obliterans with organizing pneumonia and usual interstitial pneumonia: clinical, functional, and radiologic findings.

Abstract

To assess the role of chest radiography in the differential diagnosis of bronchiolitis obliterans organizing pneumonia (BOOP) and usual interstitial pneumonia (UIP), records of 34 patients with biopsy-proved BOOP (16 patients) or UIP (18 patients) were reviewed. Chest radiographs taken before biopsy were available in 26 patients, clinical information in 33, and pulmonary function data in 22. These data were reviewed independently, without knowledge of the pathologic diagnosis. The clinical symptoms of BOOP were similar to those of UIP, although the duration of symptoms was longer in UIP (P less than .05), and the prevalence of systemic symptoms was higher in BOOP (P less than .025). The physical findings were similar except that finger clubbing was more common in patients with UIP than in those with BOOP (P less than .01). There was no significant difference in lung volumes, flows, or diffusing capacity between BOOP and UIP. The chest radiograph showed distinguishing features between UIP and BOOP in 23 of 26 patients. The most characteristic radiologic finding in BOOP was the presence of patchy areas of air-space consolidation (eight of 11 patients).

BOOP presenting with haemoptysis and multiple cavitary nodules

“…CORDIER et al [8] noted that patients with idiopathic BOOP and diffuse small nodules had a chronic disease and a worse prognosis, whilst patients with patchy infiltrates and inflammatory syndrome responded to corticosteroid therapy of a sufficient amount and duration. MÜLLER and co-workers [9,10] did not observe a case of cavitary nodules in their series. On CT of the chest, their patients presented air space consolidation, small nodular opacities, bronchial wall thickening and dilatation [9,10].…”

BOOP: an important cause of migratory pulmonary infiltrates?

“…Although COP is a diagnosis of exclusion, it is a specific clinicopathological syndrome characterized by a "pneumonia-like" illness without an associated disease [2][3][4][5][6][7][8][9][10]. There is no gender predilection, and the age at presentation is most often 45-70 yrs.…”

“…The roentgenographic manifestations associated with any illness where BOOP is a prominent histopathological lesion are often distinctive, with bilateral, diffuse alveolar opacities in the presence of normal lung volume being characteristic [4,6,8]. A peripheral distribution of the alveolar opacities, similar to that thought to be "virtually pathognomonic" for chronic eosinophilic pneumonia, is occasionally seen [3,8,9].…”

“…A peripheral distribution of the alveolar opacities, similar to that thought to be "virtually pathognomonic" for chronic eosinophilic pneumonia, is occasionally seen [3,8,9]. Irregular linear or nodular interstitial infiltrates are on rare occasions present as the only radiographic manifestation.…”

“…Other radiographic abnormalities, such as pleural effusion, pleural thickening, hyperinflation and cavities are rare. Computed tomography (CT) scans of the lung reveal patchy airspace consolidation, small nodular opacities, and bronchial wall thickening and dilation, most frequently in the periphery of the lung and often in the lower lung zone [8,12,13]. Frequently, the CT findings are far more extensive than is expected by review of the plain chest radiograph.…”