Cryptogenic Organizing Pneumonia (COP)



Cryptogenic Organizing Pneumonia Overview:

 • Idiopathic form of organizing pneumonia

 • formerly BOOP

 • Type of interstitial lung that affects the distal bronchioles, alveolar ducts and walls.

 • Secondary OP can be seen in association with CTD, drugs, malignancy and other interstitial pneumonias



Cryptogenic Organizing Pneumonia Epidemiology:

 • Unknown

 • 6-7 cases per 100,000 hospital admissions

 • 56% of OP considered cryptogenic



Cryptogenic Organizing Pneumonia - Clinical manifestations:

 • Onset: 5-6th decades of life

 • History: cough, dyspnea, fever, malaise, weight loss of > 10 pounds

 • Hemoptysis - rare



Cryptogenic Organizing Pneumonia - Imaging:

 • CXR: Peripheral distribution of opacities, Unilateral consolidation and GG pattern, irregular lines, nodular opacities. Rare: pleural effusions, pleural thickening, cavities

 • HRCT: patchy consolidation: peripheries and lower lung zone, GGO, small modular opacities, bronchial wall thickening with dilatation



Cryptogenic Organizing Pneumonia - Diagnosis:

 • Lung biopsy: TBNA or Surgical lung biopsy

 • Histopathology: Intraluminal plugs of inflammatory debris-small airways, alveolar ducts and adiacent alveoli

 • Absence of histopathology suggestive of other processes



Workup / Laboratory Studies:

 - No specific lab studies

 - Make sure to order:

	• CBC with diff

	• Chem

	• Transaminases

	• UA

	• Pneumonia: blood culture, sputum culture, urinary studies legionella/strep, HIV

	• CTD workup: ANA, RF, CCP, CPK, anti-scl70, anticentromere ab, Anti-dsDNA, ANCA



COP DDX: 

 • CAP, Idiopathic interstitial pneumonia’s, Hypersensitivity pneumonitis, Granulomatous organizing pneumonia, Chronic eosinophilia pneumonia, Pulmonary lymphoma, Diffuse alveolar damage



Cryptogenic Organizing Pneumonia Treatment:

 • Mild: observation

 • Moderate: oral glucocorticoids

 • Severe/ failure steroids: Cytotoxic Therapy



- Dr. Ravi Singh @rav7ks



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