Computed Tomographic Appearance of Organizing Pneumonia in an Oncologic Patient Population

Abstract

Objective: The aims of this study were to describe the computed tomographic features of organizing pneumonia (OP) in an oncologic patient population and to also identify features associated with lung cancer and patients undergoing hematopoietic stem cell transplant (HSCT).

Methods: In retrospective computed tomographies from 151 patients with pathologically confirmed OP between January 2009 and September 2014, number of lesions, location, size, margin type, and consistency, as well as volume of lymphadenopathy and the presence and size of pleural effusions, were recorded. Associated malignancy was noted.

Results: Organizing pneumonia most commonly presented as a diffuse process (n = 62, 41%), frequently occupied both a central and peripheral location (n = 79, 53%), and commonly presented with a solid appearance (n = 67, 44%) or with ground glass opacity (n = 80, 53%). Pleural effusions were seen in 68 patients (45%). Organizing pneumonia less frequently contained air bronchograms, cavitation, necrosis, surrounding ground glass opacity, or adjacent bronchiectasis. In patients with lung cancer (n = 25, 17%), OP more likely presented as discrete lesions and occupied a peripheral location as compared with patients with other malignancies (Ps = 0.025 and 0.002). In HSCT patients (n = 29, 19%), a diffuse process was more commonly seen than in non-HSCT patients (P = 0.038).

Conclusions: Organizing pneumonia more commonly presents as discrete lesions with a peripheral location in patients with lung cancer and as a diffuse process in patients who had undergone HSCT.

Figure 1

40 year old female with leukemia. Axial CT image demonstrates a diffuse pattern of OP predominately in the right lung lobe with both central and peripheral components (arrows).

Figure 2

64 year old male patient with pancreatic carcinoma. Axial CT image shows multifocal OP as multiple solid spiculated lesions (arrows).

Figure 3

57 year old male patient with leukemia. Axial CT image demonstrates right lower lobe mass like consolidation contacting both central (arrow) and peripheral (arrowhead) bronchi.

Figure 4

Figure 4a. 74 year old female patient with colon carcinoma. Axial CT image demonstrates OP presenting as a solid lesion in the right lower lobe (arrow). Figure 4b. 66 year old male patient with head and neck carcinoma. Axial CT image demonstrates OP presenting as a predominantly ground glass nodule in the posterior right lower lobe (arrow).

Figure 4

Figure 4a. 74 year old female patient with colon carcinoma. Axial CT image demonstrates OP presenting as a solid lesion in the right lower lobe (arrow). Figure 4b. 66 year old male patient with head and neck carcinoma. Axial CT image demonstrates OP presenting as a predominantly ground glass nodule in the posterior right lower lobe (arrow).

Figure 5

63 year old male patient with chronic lymphocytic leukemia. Axial CT image demonstrates multinodular appearance of OP (arrows) with bilateral pleural effusions (arrowheads).

Figure 6

74 year old female patient with underlying diagnosis of right lower lobe squamous cell lung carcinoma. Axial CT image demonstrates OP presenting as a solitary nodule in the periphery of the left upper lobe (arrow).

Figure 7

58 year old male patient with chronic lymphocytic leukemia presenting with cough and dyspnea 10 months following HSCT. Axial CT images demonstrate diffuse pattern of OP with bilateral ground glass opacities most pronounced in the lingula, right middle and right lower lobes (arrows).