Correct!
1. Bronchoscopy with bronchoalveolar lavage, transbronchial biopsy and brushing
The patient's course is not compatible with a typical outpatient community-acquired pneumonia. At this juncture we favored a bronchoscopy with a transbronchial biopsy, brushing and lavage. However, needle biopsy and VATS are reasonable considerations.
The bronchoscopic evaluation was negative for any infectious etiology (bacterial, fungal, mycobacterial, viral) and otherwise was unrevealing for etiology. We next elected for CT-guided core needle biopsy which showed patchy involvement of the distal airways and adjacent alveoli filled by fibromyxoid plugs of granulation tissue (Figure 4).
Figure 4. Panel A: Low power view of core biopsy. Panels B-D: Higher power view.
Neutrophils and eosinophils were infrequent and no remodeling or honeycomb changes were observed. The histology was interpreted as fragments of alveolar sac with organizing pneumonia with BOOP-like regions, which is consistent with cryptogenic organizing pneumonia (COP) (1).
Which of the following is/are true with cryptogenic organizing pneumonia? (Click on the correct answer to proceed to the next panel)