Drakopanagiotakis et al evaluated patients with organizing pneumonia. They identified factors associated with prognosis. The authors are from Sismanoglion General Hospital (Maroussi, Greece) and Brown University.
The diagnosis of organizing pneumonia is based on clinical and pathologic findings. If an underlying cause is identified it is termed secondary (SOP). If no underlying cause is identified then it is termed cryptogenic (COP).
Clinical findings are nonspecific and may include:
(1) constitutional symptoms (malaise, fever)
(2) flu-like illness
(3) cough
(4) dyspnea
The chest X-ray may show a variety of changes (bilateral alveolar infiltrates, mass, cavitation, migratory infiltrate, etc).
Pulmonary function testing shows a restrictive pattern.
Lung biopsy shows an alveolitis with loose plugs of granulation tissue (Masson bodies). Secondary organizing pneumonia may show a lymphocytosis in the bronchoalveolar lavage (> 20% lymphocytes).
Factors associated with 1-year mortality:
(1) anemia (hemoglobin < 11 g/dL)
(2) serum albumin concentration < 3.5 g/dL
(3) elevated erythrocyte sedimentation rate (ESR > 60 mm in first hour)
If the cause of the organizing pneumonia is identified (secondary), then treating or stopping the cause can improve outcome.
