An unusual radiologic pattern of cryptogenic organizing pneumonia: diffuse pulmonary nodules in a leukemia patient

Abstract

The radiological appearance of diffuse discrete pulmonary nodules associated with cryptogenic organizing pneumonia (COP) has been rarely described. We describe a case of COP in 49-year-old woman with acute myeloid leukemia who developed diffuse pulmonary nodules during the second course of induction chemotherapy. The clinical status of the patient and imaging findings suggested the presence of a pulmonary metastasis or infectious disease. A video-assisted thoracoscopic lung biopsy resulted in the unexpected diagnosis of COP as an isolated entity. Steroid therapy led to dramatic improvement of the clinical symptoms and the pulmonary lesions.

Fig. 1

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, ×200) 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, ×40). 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.