Comparison of airspace consolidation in thoracic CT between organizing pneumonia and community acquired pneumonia_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

MA Dan ¹ ,  XIAO Yonglong ¹ , ZHOU Kefeng ² , CAI Hourong ¹

1. Department of Pulmonary Medicine, Affiliated Drum Tower Hospital, Nanjing Medical University, Nanjing, Jiangshu 210008, P. R. China;
2. Department of Radiology, Affiliated Drum Tower Hospital, Nanjing Medical University, Nanjing, Jiangshu 210008, P. R. China;

Corresponding author：

XIAO Yonglong, Email: yonglong11a@163.com

Keywords：

Organizing pneumonia; Community acquired pneumonia; Airspace consolidation; Differential diagnosis

DOI：

10.7507/1671-6205.201705010

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ObjectiveTo explore the differential diagnosis value of airspace consolidation in thoracic CT between organizing pneumonia (OP) and acquired community pneumonia (CAP).MethodsA retrospective study was taken by retrieving the patients CT database from October 2010 to August 2016. Fifty-six consecutive patients with OP and 99 consecutive patients with CAP whose CT showed airspace consolidation were enrolled and their clinical characteristics and radiological characteristics were analyzed.ResultsThe percentage of patients whose CT image showed various amount of air bronchogram (ABG) with different shapes is higher in OP group than that in CAP group (87.5% and 72.7% respectively, χ²=4.558, P=0.033). The median and interquartile range amount of ABG in the OP patients were significantly higher than those in CAP group [4 (ranged from 2 to 8) and 2 (ranged from 0 to 4) respectively, z=3.640, P=0.000]. Morphologically, 58.9% of the OP patients showed entire air bronchogram (EABG) on the thoracic CT, significantly higher than that in CAP group (21.2%) (χ²=22.413, P=0.000). Interrupted ABG was found in 26.3% of CAP patients, while 16.1% of OP patients shared same features and the difference was not statistically significant (χ²=2.125, P=0.148). Traction bronchiectasis and ground glass opacity (GGO) were more likely to be found in the OP patients rather than CAP patients with 26.8% and 39.3% respectively, while they were found in 1.0% and 11.1% in the CAP patients (P<0.05). Reversed halo sign was found only 1.0% of the CAP patients, significantly lower than that in OP group, 26.8% (χ²=25.671, P=0.000). Pleural effusion and bronchial wall thickening were more commonly found in the CAP group with 56.6% and 35.4% respectively. By multivariate logistic analysis, EABG (OR=5.526, P=0.000), traction bronchiectasis (OR=21.564, P=0.010), GGO (OR=4.657, P=0.007) and reversed halo sign (OR=13.304, P=0.023) were significantly associated with OP, while pleural effusion (OR=0.380, P=0.049) and bronchial wall thickening (OR=0.073, P=0.008) were significantly associated with CAP. Other features in thoracic CT coexisting with ABG all reach significance statistically between the OP and CAP group (all P<0.05).ConclusionsAirspace consolidation in thoracic CT may be valuable for the differential diagnosis between OP and CAP. EABG is more commonly found in OP patients than in CAP patients. When EABG exists or ABG coexists with traction bronchiectasis, GGO and reversed halo sign, a diagnose of OP should be considered.

Citation： MA Dan, XIAO Yonglong, ZHOU Kefeng, CAI Hourong. Comparison of airspace consolidation in thoracic CT between organizing pneumonia and community acquired pneumonia. Chinese Journal of Respiratory and Critical Care Medicine, 2018, 17(3): 247-254. doi: 10.7507/1671-6205.201705010 Copy

1.	Roberton BJ, Hansell DM. Organizing pneumonia: a kaleidoscope of concepts and morphologies. Eur Radiol, 2011, 21(11): 2244-2254.
2.	Lee JW, Lee KS, Lee HY, et al. Cryptogenic organizing pneumonia: serial high-resolution CT findings in 22 patients. Am J Roentgenol, 2010, 195(4): 916-922.
3.	Oikonomou A, Hansell DM. Organizing pneumonia: the many morphological faces. Eur Radiol, 2002, 12(6): 1486-1496.
4.	Hansell DM, Bankier AA, MacMahon H, et al. Fleischner Society: glossary of terms for thoracic imaging. Radiology, 2008, 246(3): 697-722.
5.	Travis WD, Costabel U, Hansell DM, et al. An official American Thoracic Society/European Respiratory Society statement: update of the international multidisciplinary classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med, 2013, 188(6): 733-748.
6.	Wells AU, Hirani N. Interstitial lung disease guideline: the British Thoracic Society in collaboration with the Thoracic Society of Australia and New Zealand and the Irish Thoracic Society. Thorax, 2008, 63: v1-v58.
7.	中华医学会呼吸病学分会. 社区获得性肺炎诊断和治疗指南. 中华结核和呼吸杂志, 2006, 29(10): 651-655.
8.	Nambu A, Ozawa K, Kobayashi N, et al. Imaging of community-acquired pneumonia: roles of imaging examinations, imaging diagnosis of specific pathogens and discrimination from noninfectious diseases. World J Radiol, 2014, 6(10): 779-793.
9.	Baque-Juston M, Pellegrin A, Leroy S, et al. Organizing pneumonia: What is it? A conceptual approach and pictorial review. Diagn Interv Imaging, 2014, 95(9): 771-777.
10.	Faria IM, Zanetti G, Barreto MM, et al. Organizing pneumonia: chest HRCT findings. J Bras Pneumol, 2015, 41(3): 231-237.
11.	Marchiori E, Zanetti G, Escuissato DL, et al. Reversed halo sign: high-resolution CT scan findings in 79 patients. Chest, 2012, 141(5): 1260-1266.
12.	Rea G, Lassandro F, Valente T. Exogenous lipoid pneumonia in laryngectomy patients: Is ground glass opacity/crazy paving pattern an organizing pneumonia reaction that can predict poor outcome?. Arch Bronconeumol, 2016, 52(8): 438-439.
13.	Nei T, Yamano Y, Sakai F, et al. Mycoplasma pneumoniae pneumonia: differential diagnosis by computerized tomography. Intern Med, 2007, 46(14): 1083-1087.
14.	Dai J, Shi JY, Soodeen-Lallo AK, et al. Air bronchogram: a potential indicator of epidermal growth factor receptor mutation in pulmonary subsolid nodules. Lung Cancer, 2016, 98: 22-28.
15.	Jung JI, Kim H, Park SH, et al. CT differentiation of pneumonic-type bronchioloalveolar cell carcinoma and infectious pneumonia. Br J Radiol, 2001, 74(882): 490-494.
16.	Cadranel J, Wislez M, Antoine M. Primary pulmonary lymphoma. Eur Respir, 2002, 20(3): 750-762.
17.	Gudmundsson G, Sveinsson O, Isaksson HJ, et al. Epidemiology of organizing pneumonia in Iceland. Thorax, 2006, 61(9): 805-808.
18.	Ward E, Rog J. Bronchiolitis obliterans organizing pneumonia mimicking community-acquired pneumonia. J Am Board Fam Pract, 1998, 11(1): 41-45.
19.	Banka R, Ward MJ. Bronchiolitis obliterans and organising pneumonia caused by carbamazepine and mimicking community acquired pneumonia. Postgrad Med J, 2002, 78(924): 621-622.
20.	Rea G, Pignatiello M, Longobardi L, et al. Diagnostic clues of organizing pneumonia: a case presentation. Quant Imaging Med Surg, 2017, 7(1): 144-148.
21.	Feinstein MB, DeSouza SA, Moreira AL, et al. A comparison of the pathological, clinical and radiographical, features of cryptogenic organising pneumonia, acute fibrinous and organising pneumonia and granulomatous organising pneumonia. J Clin Pathol, 2015, 68(6): 441-447.
22.	Huo Z, Feng R, Tian X, et al. Clinicopathological findings of focal organizing pneumonia: a retrospective study of 37 cases. Int J Clin Exp Pathol, 2015, 8(1): 511-516.

1. Roberton BJ, Hansell DM. Organizing pneumonia: a kaleidoscope of concepts and morphologies. Eur Radiol, 2011, 21(11): 2244-2254.
2. Lee JW, Lee KS, Lee HY, et al. Cryptogenic organizing pneumonia: serial high-resolution CT findings in 22 patients. Am J Roentgenol, 2010, 195(4): 916-922.
3. Oikonomou A, Hansell DM. Organizing pneumonia: the many morphological faces. Eur Radiol, 2002, 12(6): 1486-1496.
4. Hansell DM, Bankier AA, MacMahon H, et al. Fleischner Society: glossary of terms for thoracic imaging. Radiology, 2008, 246(3): 697-722.
5. Travis WD, Costabel U, Hansell DM, et al. An official American Thoracic Society/European Respiratory Society statement: update of the international multidisciplinary classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med, 2013, 188(6): 733-748.
6. Wells AU, Hirani N. Interstitial lung disease guideline: the British Thoracic Society in collaboration with the Thoracic Society of Australia and New Zealand and the Irish Thoracic Society. Thorax, 2008, 63: v1-v58.
7. 中华医学会呼吸病学分会. 社区获得性肺炎诊断和治疗指南. 中华结核和呼吸杂志, 2006, 29(10): 651-655.
8. Nambu A, Ozawa K, Kobayashi N, et al. Imaging of community-acquired pneumonia: roles of imaging examinations, imaging diagnosis of specific pathogens and discrimination from noninfectious diseases. World J Radiol, 2014, 6(10): 779-793.
9. Baque-Juston M, Pellegrin A, Leroy S, et al. Organizing pneumonia: What is it? A conceptual approach and pictorial review. Diagn Interv Imaging, 2014, 95(9): 771-777.
10. Faria IM, Zanetti G, Barreto MM, et al. Organizing pneumonia: chest HRCT findings. J Bras Pneumol, 2015, 41(3): 231-237.
11. Marchiori E, Zanetti G, Escuissato DL, et al. Reversed halo sign: high-resolution CT scan findings in 79 patients. Chest, 2012, 141(5): 1260-1266.
12. Rea G, Lassandro F, Valente T. Exogenous lipoid pneumonia in laryngectomy patients: Is ground glass opacity/crazy paving pattern an organizing pneumonia reaction that can predict poor outcome?. Arch Bronconeumol, 2016, 52(8): 438-439.
13. Nei T, Yamano Y, Sakai F, et al. Mycoplasma pneumoniae pneumonia: differential diagnosis by computerized tomography. Intern Med, 2007, 46(14): 1083-1087.
14. Dai J, Shi JY, Soodeen-Lallo AK, et al. Air bronchogram: a potential indicator of epidermal growth factor receptor mutation in pulmonary subsolid nodules. Lung Cancer, 2016, 98: 22-28.
15. Jung JI, Kim H, Park SH, et al. CT differentiation of pneumonic-type bronchioloalveolar cell carcinoma and infectious pneumonia. Br J Radiol, 2001, 74(882): 490-494.
16. Cadranel J, Wislez M, Antoine M. Primary pulmonary lymphoma. Eur Respir, 2002, 20(3): 750-762.
17. Gudmundsson G, Sveinsson O, Isaksson HJ, et al. Epidemiology of organizing pneumonia in Iceland. Thorax, 2006, 61(9): 805-808.
18. Ward E, Rog J. Bronchiolitis obliterans organizing pneumonia mimicking community-acquired pneumonia. J Am Board Fam Pract, 1998, 11(1): 41-45.
19. Banka R, Ward MJ. Bronchiolitis obliterans and organising pneumonia caused by carbamazepine and mimicking community acquired pneumonia. Postgrad Med J, 2002, 78(924): 621-622.
20. Rea G, Pignatiello M, Longobardi L, et al. Diagnostic clues of organizing pneumonia: a case presentation. Quant Imaging Med Surg, 2017, 7(1): 144-148.
21. Feinstein MB, DeSouza SA, Moreira AL, et al. A comparison of the pathological, clinical and radiographical, features of cryptogenic organising pneumonia, acute fibrinous and organising pneumonia and granulomatous organising pneumonia. J Clin Pathol, 2015, 68(6): 441-447.
22. Huo Z, Feng R, Tian X, et al. Clinicopathological findings of focal organizing pneumonia: a retrospective study of 37 cases. Int J Clin Exp Pathol, 2015, 8(1): 511-516.

Chinese Journal of Respiratory and Critical Care Medicine

Comparison of airspace consolidation in thoracic CT between organizing pneumonia and community acquired pneumonia

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