Cryptogenic organizing pneumonia other diagnostic studies

Pulmonary function test may be helpful in the diagnosis of cryptogenic organizing pneumonia. The most common finding in cryptogenic organizing pneumonia is mild to moderate restrictive ventilatory defect and DLCO is reduced. Flexible bronchoscopy is performed to obtain bronchoalveolar lavage sample (BAL) and transbronchial biopsy.

Pulmonary function test

• Pulmonary function test is helpful in the diagnosis of cryptogenic organizing pneumonia.
• Findings suggestive of cryptogenic organizing pneumonia include:
  • The most common finding in cryptogenic organizing pneumonia is mild to moderate restrictive ventilatory defect.
  • In rare cases, it shows an obstructive pattern (FEV1/FVC less than 70 percent).
  • DLCO is reduced.

Flexible bronchoscopy

• Flexible bronchoscopy is performed to obtain bronchoalveolar lavage sample (BAL) and transbronchial biopsy.

Bronchoalveolar Lavage

• BAL is done to know the etiology of cryptogenic organizing pneumonia.
• Various abnormal cells seen in cryptogenic organizing pneumonia are:
  • Foamy macrophages, mast cells, plasma cells.
  • A decreased CD4/CD8 T cell ratio.
  • An increase in activated T lymphocytes based on HLA-DR or interleukin-2 receptor expression.^[1]

Transbronchial biopsy

• CT guided biposy is better and reduces the need surgical biopsy.
• Histological finding which helps to diagnose cryptogenic organizing pneumonia are:
  • There is intraluminal plugs of inflammatory debris which consist of granulation tissue found within small airways, alveolar ducts, and adjacent alveoli.
  • There is a mild interstitial inflammation in the surrounding lung.^[2]