Table of contents

BOOP (Bronchiolitis Obliterans with Organizing Pneumonia)

HPI:

PMHx / PSHx

FHx

SHx

Meds / Allergies

ROS:

PE

NECK: No JVD, or carotid bruits. Slightly enlarged thyroid, Bilat tonsilar lymphadenopathy. LUNGS: Diffuse crackles bilat w/ good air movement. HEART: RRR, S1 and S2. No murmurs.

ABD: Soft, Non distended. Tenderness to palpation on RUQ. No hepatosplenomegaly. EXT: No clubbing, no cyanosis, and no edema. MUSCULOSKELETAL: Right sided is weaker than left. +5/5 muscle strength bilat.

NEURO: No aphasia. Negative for Romberg or Babinski. Intact sensory and motor functions RECTUM: good sphincter tone. No external hemorrhoids.

LABORATORIES

ABG: pH 7.47, PaCO2 36, PaO2 71, bicarbonate 26 and O2 sat 94% on room air. Cardio enzymes (CK, CKMB, troponin):wnl Thyroid Functions: wnl Negative for UA and hemoccult HIV neg and wnl lymphocytic profile, Negative for Viral Hepatitis profile (Hep Bs Ag, Hep Bc IgM, Hep C, Hep A IgM)

Negative ACE An elevated Sed rate 116 (0-20) Negative PPD, 3 consecut. neg AFB smears, neg urine AFB, neg sputum Cx, and no growth in blood Cx x 2 EKG: normal sinus rhythm. CXR: bilateral infiltrates in the upper lobes; the possibility of TB.

CT chest: infiltrate was not really apical posterior, more anterior in upper lobes A bronchoscopy w/ bronchial-alveolar lavage (BAL) and transbronchial biopsy BAL from ant. seg of RT upper lobe Moderate growth of Pseudomonas aeruginosa. No AFB or fungus.

Pulmonary parenchyma w/ fibromyxoid alveolar plugs containing moderate numbers of eosinophils No granulomata are evident. No evidence of malignancy

Generalized weakness on RT

Dx

Bronchiolitis

Respiratory bronchioles & alveoli

Constrictive Bronchiolitis

Slide 22

Proliferative Bronchiolitis

BOOP (Cryptogenic Organizing Pneumonia)

Table 1 Bronchiolitis Oblitrans (Constrictive Bronchiolitis Pattern) Compared to BOOP

BOOP-Epidemiology

Pathophysiology of BOOP

Normal Apoptotic activity of vascular growth factors in the fibromyxoid lesion of BOOP unlike UIP/IPF. Apoptosis has a significant role in the resolution of the BOOP

Typical clinical S/S of BOOP

Dx and Tx

Recurrence of BOOP

Types of BOOP

Idiopathic BOOP

Rapidly Progressive BOOP

Focal nodular BOOP

Multiple nodular lesions BOOP

Post-infection BOOP

Drug-related BOOP

Rheumatologic or connective tissue BOOP

Immunologic, organ transplantation and radiotherapy associated BOOP Environment/occupation –related BOOP A case study: cavitating BOOP assoc w/ benzalkonium compounds in a floor cleaner.

Clinical classification of bronchiolitis

Slide 42

Discussion

Tx prior to bronchoscopy

Special thanks to Dr. Singer, Dr. Hull and Internal medicine team.

References

Author: Frank Hull, MD.

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