Dijagnostički pristup lokalizovanoj organizovanoj pneumoniji
Sažetak
Uvod. Lokalizovana organizovana pneumonija, predstavljena ovalnim ili okruglim senkama, zbog sumnje na karcinom bronha ili metastaze, čini diferencijalno dijagnostički problem. Prikaz bolesnika. Prikazana je bolesnica koja je hospitalizovana radi razjašnjenja etiologije multiplih nodularnih plućnih promena. Radiogram grudnog koša pokazao je obostrana mrljasta i nodularna zasenčenja, a kompjuterizovana tomografija obostrane okruglaste promene. Pregledi sputuma i patohistološke analize materijala uzetih tokom bronhoskopije nisu razjasnili etiologiju promena. Zbog sumnje na sekundarne depozite u plućima, urađena je videoasistirana torakoskopija i anterolateralna desna mini torakotomija sa atipičnom resekcijom gornjeg i donjeg režnja. Ex tempore nalaz ukazao je na benignost promene, a definitivni patohistološki nalaz na lokalizovanu organizovanu pneumoniju. Zbog obostranih plućnih promena primenjeni su kortikosteroidi. Nakon sedam nedelja nalaz kompjuterizovane tomografije ukazao je na potpunu regresiju promena. Zaključak. Hirurška resekcija bila je neophodna u dijagnostici lokalizovane organizovana pneumonija koja je ličila na sekundarne maligne lezije, a u cilju definitivnog razjašnjenja etiologije promena u plućima. Nedavnim uvođenjem bronhoskopske kriobiopsije bioptata otvorene su nove mogućnosti u dijagnostici i terapiji neoplazmi i drugih bolesti pluća.
Reference
Cordier JF. Organising pneumonia. Thorax 2000; 55(4): 318−28.
Cordier JF. Cryptogenic organising pneumonia. Eur Respir J 2006; 28(2): 422−46.
Yang PS, Lee KS, Han J, Kim EA, Kim TS, Choo IW. Focal or-ganizing pneumonia: CT and pathologic findings. J Korean Med Sci 2001; 16(5): 573−8.
Furuya K, Yasumori K, Takeo S, Sakino I, Uesugi N, Momosaki S, Muranaka T. Lung CT: Part 1, Mimickers of lung cancer--spectrum of CT findings with pathologic correlation. AJR Am J Roentgenol 2012; 199(4): W454−63.
Alikhan M, Veeraghavan S. Empiric Treatment of Focal Organ-izing Pneumonia in a Patient with a Low - Risk Lung Mass. Case Rep Pulmonol 2013; 2013: 340202.
Kevin OL, Mark RW. Practical Pulmonary Pathology A diag-nostic approach. 2nd ed. St. Louis, Mo: Elsevier Saunders; 2005.
Travis WD, Costabel U, Hansell DM, King TE, Lynch DA, Nichol-son AG, 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): 733−48.
Kropski JA, Pritchett JM, Mason WR, Sivarajan L, Gleaves LA, Johnson JE, et al. Bronchoscopic cryobiopsy for the diagnosis of diffuse parenchymal lung disease. PLoS One 2013; 8(11): e78674.
Babiak A, Hetzel J, Krishna G, Fritz P, Moeller P, Balli T, et al. Transbronchial cryobiopsy: a new tool for lung biopsies. Res-piration 2009; 78(2): 203−8.
Casoni GL, Tomassetti S, Cavazza A, Colby TV, Dubini A, Ryu JH, et al. Transbronchial lung cryobiopsy in the diagnosis of fibrotic interstitial lung diseases. PLoS ONE 2014; 9(2): e86716.
Griff S, Ammenwerth W, Schonfeld N, Bauer TT, Mairinger T, Blum TG et al. Morphometrical analysis of transbronchial cryobiop-sies. Diagn Pathol 2011; 6: 53.
Schuhmann M, Bostanci K, Bugalho A, Warth A, Schnabel PA, Herth FJ, et al. Endobronchial ultrasound-guided cryobiopsies in peripheral pulmonary lesions: a feasibility study. Eur Respir J 2014; 43(1): 233−9.
Wu CT, Chang YL, Chen WC, Lee YC. Surgical treatment of or-ganising pneumonia mimicking lung cancer: experience of 27 patients. Eur J Cardiothorac Surg 2010; 37(4): 797−801.
Maldonado F, Daniels CE, Hoffman EA, Yi ES, Ryu JH. Focal organizing pneumonia on surgical lung biopsy: causes, clinico-radiologic features, and outcomes. Chest 2007; 132(5): 1579−83.
Melloni G, Cremona G, Bandiera A, Arrigoni G, Rizzo N, Varagona R, et al. Localized organizing pneumonia: report of 21 cases. Ann Thorac Surg 2007; 83(6): 1946−51.
Maldonado F, Daniels CE, Hoffman EA, Yi ES, Ryu JH. Focal organizing pneumonia on surgical lung biopsy: causes, clinico-radiologic features, and outcomes. Chest 2007; 132(5): 1579−83.
Zheng Z, Pan Y, Song C, Wei H, Wu S, Wei X, et al. Focal organ-izing pneumonia mimicking lung cancer: a surgeon's view. Am Surg 2012; 78(1): 133−7.
Drakopanagiotakis F, Polychronopoulos V, Judson MA. Organizing pneumonia. Am J Med Sci 2008; 335(1): 34−9.
Yoo J, Song JW, Jang SJ, Lee CK, Kim M, Lee H, et al. Compari-son between cryptogenic organizing pneumonia and connec-tive tissue disease-related organizing pneumonia. Rheumatolo-gy 2011; 50(5): 932-8.