Organizing pneumonia

Last reviewed: 5 Jan 2023
Last updated: 17 Nov 2022

Summary

Definition

History and exam

Key diagnostic factors

  • flu-like illness with low-grade fever, fatigue, and arthralgia
More key diagnostic factors

Other diagnostic factors

  • cough
  • shortness of breath
  • bilateral crackles
Other diagnostic factors

Risk factors

  • infectious pneumonia
  • connective tissue diseases
  • immunologic diseases and inflammatory bowel disease
  • organ transplantation
  • medication use
  • breast radiation therapy
  • exposure to toxins
More risk factors

Diagnostic investigations

1st investigations to order

  • chest x-ray
  • high-resolution chest CT scan (HRCT)
  • CBC
  • erythrocyte sedimentation rate
More 1st investigations to order

Investigations to consider

  • C-reactive protein
  • sputum culture
  • atypical viral screen
  • pulmonary function tests
  • surgical lung biopsy
  • creatine kinase
  • general autoimmune and myositis profile
  • positron emission tomography (PET) scan
  • bronchoscopy
More investigations to consider

Treatment algorithm

INITIAL

rapidly progressive OP

ACUTE

cryptogenic OP

secondary OP

ONGOING

recurrent OP, rapidly progressive

recurrent OP, not rapidly progressive

Contributors

Authors

O'Neil Green, MBBS, FCCP

Assistant Professor in Medicine

Director, NTM and Bronchiectasis Clinic

UMass Chan School of Medicine/Baystate Health

Worcester

MA

Disclosures

OG declares that he has no competing interests.

Jean-Pierre Assaker, MD

Pulmonary and Critical Care Fellow

UMass Chan School of Medicine/Baystate Health

Worcester

MA

Disclosures

JA declares that he has no competing interests.

Acknowledgements

Dr O’Neil Green and Dr Jean-Pierre Assaker would like to gratefully acknowledge Dr Gary R. Epler, the previous contributor to this topic.

Disclosures

GRE is an author of several references cited in this topic.

Peer reviewers

Nazia Chaudhuri, MbChB, BSc, PhD, FRCP

Clinical Lead of ILD Service

Manchester University NHS Foundation Trust

Manchester

UK

Disclosures

NC declares that she has no competing interests.

Steven Sahn, MD

Professor of Medicine and Director

Division of Pulmonary/Critical Care/Allergy/Sleep Medicine

Medical University of South Carolina

Charleston

SC

Disclosures

SS declares that he has no competing interests.

Teofilo Lee-Chiong, MD

National Jewish Medical and Research Center

Denver

CO

Disclosures

TLC has been reimbursed by the American College of Chest Physicians (ACCP), American Academy of Sleep Medicine, American Thoracic Society, and Cephalon, the manufacturer of modafinil, for attending several conferences. He has been paid by the ACCP for running educational programs and by Elsevier for serving as consultant of the Sleep Medicine Clinics. He has also received research funding from the National Institutes of Health, Respironics, Restore, and Schwarz Pharma, and has been a member of the speakers' bureau for GlaxoSmithKline.

  • Organizing pneumonia images
  • Differentials

    • Nodular sarcoidosis
    • Chronic eosinophilic pneumonia (CEP)
    • Nonspecific interstitial pneumonia (NSIP)
    More Differentials
  • Guidelines

    • Korean guidelines for diagnosis and management of interstitial lung diseases: part 4. cryptogenic organizing pneumonia
    • An official American Thoracic Society/European Respiratory Society statement: update of the international multidisciplinary classification of the idiopathic interstitial pneumonias
    More Guidelines
  • Patient leaflets

    Pneumonia

    More Patient leaflets
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer