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Organising Pneumonia — RACP Adult Medicine MCQ

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ModerateRespiratoryOrganising PneumoniaRACP Adult Medicine

A 60-year-old man with a history of radiation therapy for lymphoma 2 years ago presents with cough and dyspnoea. HRCT shows bilateral patchy consolidation with air bronchograms in a peribronchial distribution, some migratory over serial imaging. Lung biopsy shows intra-alveolar buds of granulation tissue (Masson bodies). What is the most likely ILD pattern?

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Correct answer: C — Organising pneumonia

Migratory patchy consolidation with air bronchograms, peribronchial distribution, and Masson bodies (intra-alveolar organising fibrosis) on biopsy is cryptogenic organising pneumonia (COP). It can be secondary to radiation, drugs, infection, or CTD. COP responds dramatically to corticosteroids (~80%) but relapses are common on tapering (~50%). Treatment: prednisolone 0.75 mg/kg for 4 weeks then taper over 6-12 months. Distinguish from invasive mucinous adenocarcinoma (also migratory consolidation).

Reference: ATS/ERS – 2013 – IIP; eTG Respiratory 2024