Bronchiolitis Obliterans Organizing Pneumonia: BOOP The characteristic of organizing pneumonia is the appearance of tissue in the distal bronchioles. BOOP can be classified by 1) its cause 2) the cause is undetermined 3) its cryptogenic organizing pneumonia (idiopathic type).
About one-half of all cases of BOOP are idiopathic. BOOP on x-ray can also be confused with chronic pneumonia (CEP).
The difference between the two is that BOOP has consolidation in the lower lobes of the lung and CEP consolidation is found in the upper lobes. The definitive diagnosis of BOOP comes down to tissue biopsy.
Conditions that cause BOOP are radiation therapy, infections, drugs / toxins , connective tissue disease, immune-suppressed states, and miscellaneous conditions. The radiation therapy causes BOOP when there is a cancer in the bronchi or breast cancer and the lung develops BOOP. The only common type of infection that causes BOOP is pseudo monas. The other types are burnet ili, , , influenza A, measles, HIV, Chlamydia, plasmodium and B 19.
When BOOP occurs in conjunction with drugs / toxins the common drug causes are, , , , , , , Dilantin, and bet apace. The toxins include L-tryptophan ingestion, androgynous vegetable poisoning, gold, paint aerosols, nylon flock worker’s and silo filler’s disease, free-base cocaine, and smoke inhalation. Connective tissue diseases include rheumatoid arthritis, ankylosing spondylitis, ulcerative colitis, Crohn disease, systemic lupus, biliary cirrhosis and thyroiditis. The immune suppressed causes are commonly due to organ transplantation, cancer, ARDS and AIDS. One of the miscellaneous causes of BOOP is menstrual and pregnancy related. Clinically, BOOP affects ages 40-70 but has been reported in children.
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The course commonly follows a flu-like symptoms, illness lasting 1-4 months with persistent non productive cough, dyspnea on exertion, low grade pyrexia, malaise and weight loss. BOOP can be assumed over pneumonia when there is no response to antibiotics, there are lung crepitations, and PFT will show a restrictive pattern with decreased D LCO and exercise related. Chest x-ray is a good indicator but CT scan is more concise. The only treatment for BOOP are steroids and all other therapies are supportive (i. e. Oxygen, ventilator).
Bronchoscopy is a common procedure when BOOP is suspected. When a biopsy is taken there is usually an increase in the normal amount of lymph’s 20-40%, eosinophils 5%, neutrophils 10% and macrophages present. Chest x-ray will show bilateral / unilateral patchy alveolar consolidation in the lower lobes. The consolidation is non-segmental and about 2-6 cm in area with the presence of nodules 3-5 mm seen in half of all cases. CT scan reveals patchy ground-glass opacities, bilateral basal airspace consolidation, bronchial wall thickening and cylindrical dilation.
Even though both of these diagnostic techniques are detailed they can be confused with other interstitial, inflammatory or neoplastic diseases and biopsy is the true indicator of BOOP.