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Chest Imaging

Bronchiolitis obliterans organizing pneumonia

(BOOP), disease characterized pathologically by the presence of granulation tissue polyps in the lumen of bronchioles and alveolar ducts and patchy areas of organizing pneumonia, consisting largely of mononuclear cells and foamy macrophages. It is also known as cryptogenic organizing pneumonia. Most cases are idiopathic, but BOOP may also be seen with pulmonary infection, drug reactions, collagen vascular diseases and Wegeners granulomatosis chest, and after inhalation of toxic fumes. Patients with BOOP typically present with a history of several months of nonproductive cough, low-grade fever, malaise and shortness of breath. Pulmonary function tests usually show a restrictive pattern. Characteristic radiological features of BOOP consist of patchy, nonsegmental, unilateral or bilateral areas of air space consolidation, (Fig.1). HRCT findings in patients with BOOP include:

  • patchy consolidation or ground glass opacity, often with a subpleural and/or peribronchial distribution (Fig. 1 b);

  • small ill-defined nodules which may be peribronchial or peribronchiolar; and

  • bronchial wall thickening or dilatation in abnormal lung regions.

    Patients usually respond to treatment with steroids.

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    Fig.1

    Patient suffering from idiopathic BOOP. a. Chest radiograph showing bilateral patchy areas of air-space consolidation predominantly distributed in the lung base. b: HRCT scan at the level of the upper lobes demonstrating the presence of patchy areas of air-space consolidation containing air bronchogram.
    Bronchiolitis obliterans organizing pneumonia, Fig.1 (a)
    Bronchiolitis obliterans organizing pneumonia, Fig.1 (b)