Typische und atypische Morphologie der kryptogen organisierenden Pneumonie in der Computertomografie

Zusammenfassung

Die organisierende Pneumonie (OP) tritt sowohl idiopathisch auf („kryptogen organisierende Pneumonie”) als auch als Folge unterschiedlichster Auslöser („sekundär organisierende Pneumonie”). Häufige Trigger sind Infektionen, Medikamente, Kollagenosen, chronisch entzündliche Darmerkrankungen, Organtransplantationen und Bestrahlungen im Thorakalbereich. Die vorliegende Arbeit gibt einen Überblick über die histopathologischen, klinischen und CT-morphologischen Charakteristika der OP. Hierbei werden sowohl die klassischen, bildgebenden Zeichen (periphere oder peribronchovaskuläre Konsolidierungen und Milchglastrübungen) als auch atypische Morphologien (Noduli, Crazy Paving, Linien und Bänder, perilobuläre Konsolidierungen und das Reversed Halo Zeichen) vorgestellt.

Abstract

Organizing pneumonia (OP) occurs without any identifiable cause (”cryptogenic organizing pneumonia”) as well as secondary to a multitude of disorders of various origins (”secondary organizing pneumonia”). Possible triggers are infections, drugs, collagen vascular disease, inflammatory bowel disease, transplantations, and radiation directed to the chest. The present manuscript provides an overview of the histopathological, clinical and CT imaging features of OP. Classic CT morphologies (peripheral and peribronchovascular consolidations and ground glass opacities) and atypical imaging features (nodules, crazy paving, lines and bands, perilobular consolidations and the reversed halo sign) are discussed.

Key words

thorax - CT - inflammation

Literatur

• 1 Cordier J F. Organizing pneumonia: cryptogenic and disease associated.  Semin Respir Crit Care Med. 2003;  24 595-606
• 2 Davison A G, Heard B E, McAllister W A. et al . Cryptogenic organizing pneumonitis.  Q J Med. 1983;  52 382-394
• 3 American Thoracic Society/European Respiratory Society . International Multidisciplinary Consensus Classification of the Idiopathic Interstitial Pneumonias.  Am J Respir Crit Care Med. 2002;  165 277-304
• 4 Lohr R H, Boland B J, Douglas W W. et al . Organizing pneumonia. Features and prognosis of cryptogenic, secondary, and focal variants.  Arch Intern Med. 1997;  157 1323-1329
• 5 Schlesinger C, Koss M N. The organizing pneumonias: an update and review.  Curr Opin Pulm Med. 2005;  11 422-430
• 6 Oikonomou A, Hansell D M. Organizing pneumonia: the many morphological faces.  Eur Radiol. 2002;  12 1486-1496
• 7 Takigawa N, Segawa Y, Saeki T. et al . Bronchiolitis obliterans organizing pneumonia syndrome in breast-conserving therapy for early breast cancer: radiation-induced lung toxicity.  Int J Radiat Oncol Biol Phys. 2000;  48 751-755
• 8 Miwa S, Morita S, Suda T. et al . The incidence and clinical characteristics of bronchiolitis obliterans organizing pneumonia syndrome after radiation therapy for breast cancer.  Sarcoidosis Vasc Diffuse Lung Dis. 2004;  21 212-218
• 9 Crestani B, Valeyre D, Roden S. et al . Bronchiolitis obliterans organizing pneumonia syndrome primed by radiation therapy to the breast. The Groupe d’Etudes et de Recherche sur les Maladies Orphelines Pulmonaires (GERM„O”P).  Am J Respir Crit Care Med. 1998;  158 1929-1935
• 10 Cordier J F. Organising pneumonia.  Thorax. 2000;  55 318-328
• 11 Murphy J, Schnyder P, Herold C. et al . Bronchiolitis obliterans organising pneumonia simulating bronchial carcinoma.  Eur Radiol. 1998;  8 1165-1169
• 12 King T E, Mortenson R L. Cryptogenic organizing pneumonitis. The North American experience.  Chest. 1992;  102 8S-13S
• 13 Myers J L, Colby T V. Pathologic manifestations of bronchiolitis, constrictive bronchiolitis, cryptogenic organizing pneumonia, and diffuse panbronchiolitis.  Clin Chest Med. 1993;  14 611-622
• 14 Chang Jr J, Han J, Kim D W. et al . Bronchiolitis obliterans organizing pneumonia: clinicopathologic review of a series of 45 Korean patients including rapidly progressive form.  J Korean Med Sci. 2002;  17 179-186
• 15 Cohen A J, King T E, Downey G P. Rapidly progressive bronchiolitis obliterans with organizing pneumonia.  Am J Respir Crit Care Med. 1994;  149 1670-1675
• 16 Yousem S A, Lohr R H, Colby T V. Idiopathic bronchiolitis obliterans organizing pneumonia/cryptogenic organizing pneumonia with unfavorable outcome: pathologic predictors.  Mod Pathol. 1997;  10 864-871
• 17 Cordier J F. Cryptogenic organizing pneumonitis. Bronchiolitis obliterans organizing pneumonia.  Clin Chest Med. 1993;  14 677-692
• 18 Nizami I Y, Kissner D G, Visscher D W. et al . Idiopathic bronchiolitis obliterans with organizing pneumonia. An acute and life-threatening syndrome.  Chest. 1995;  108 271-277
• 19 Muller N L, Staples C A, Miller R R. Bronchiolitis obliterans organizing pneumonia: CT features in 14 patients.  Am J Roentgenol. 1990;  154 983-987
• 20 Arakawa Jr H, Kurihara Y, Niimi H. et al . Bronchiolitis obliterans with organizing pneumonia versus chronic eosinophilic pneumonia: high-resolution CT findings in 81 patients.  Am J Roentgenol. 2001;  176 1053-1058
• 21 Ujita M, Renzoni E A, Veeraraghavan S. et al . Organizing pneumonia: perilobular pattern at thin-section CT.  Radiology. 2004;  232 757-761
• 22 Kim S J, Lee K S, Ryu Y H. et al . Reversed halo sign on high-resolution CT of cryptogenic organizing pneumonia: diagnostic implications.  Am J Roentgenol. 2003;  180 1251-1254
• 23 Watanabe K, Harada T, Yoshida M. et al . Organizing pneumonia presenting as a solitary nodular shadow on a chest radiograph.  Respiration. 2003;  70 507-514
• 24 Lee K S, Kullnig P, Hartman T E. et al . Cryptogenic organizing pneumonia: CT findings in 43 patients.  Am J Roentgenol. 1994;  162 543-546
• 25 Dodd J D, Muller N L. Bronchiolitis obliterans organizing pneumonia after bone marrow transplantation: high-resolution computed tomography findings in 4 patients.  J Comput Assist Tomogr. 2005;  29 540-543
• 26 Muller N L, Miller R R. Diseases of the bronchioles: CT and histopathologic findings.  Radiology. 1995;  196 3-12
• 27 Johkoh T, Itoh H, Muller N L. et al . Crazy-paving appearance at thin-section CT: spectrum of disease and pathologic findings.  Radiology. 1999;  211 155-160
• 28 Rossi S E, Erasmus J J, Volpacchio M. et al . „Crazy-paving” pattern at thin-section CT of the lungs: radiologic-pathologic overview.  Radiographics. 2003;  23 1509-1519
• 29 Murphy J M, Schnyder P, Verschakelen J. et al . Linear opacities on HRCT in bronchiolitis obliterans organising pneumonia.  Eur Radiol. 1999;  9 1813-1817
• 30 Johkoh T, Muller N L, Ichikado K. et al . Perilobular pulmonary opacities: high-resolution CT findings and pathologic correlation.  J Thorac Imaging. 1999;  14 172-177
• 31 Akira M, Yamamoto S, Sakatani M. Bronchiolitis obliterans organizing pneumonia manifesting as multiple large nodules or masses.  Am J Roentgenol. 1998;  170 291-295
• 32 Preidler K W, Szolar D M, Moelleken S. et al . Distribution pattern of computed tomography findings in patients with bronchiolitis obliterans organizing pneumonia.  Invest Radiol. 1996;  31 251-255
• 33 Gasparetto E L, Escuissato D L, Davaus T. et al . Reversed halo sign in pulmonary paracoccidioidomycosis.  Am J Roentgenol. 2005;  184 1932-1934
• 34 Zompatori M, Poletti V, Battista G. et al . Bronchiolitis obliterans with organizing pneumonia (BOOP), presenting as a ring-shaped opacity at HRCT (the atoll sign). A case report.  Radiol Med. 1999;  97 308-310
• 35 Voloudaki A E, Bouros D E, Froudarakis M E. et al . Crescentic and ring-shaped opacities. CT features in two cases of bronchiolitis obliterans organizing pneumonia (BOOP).  Acta Radiol. 1996;  37 889-892
• 36 Heyer C M, Peters S, Lemburg S. et al . Einschätzung der Strahlenbelastung radiologischer Thorax-Verfahren: Was ist Nicht-Radiologen bekannt?.  Fortschr Röntgenstr. 2007;  179 261-267