Radiographic patterns in the diagnostic approach to organizing pneumonia

Abstract A 56-year-old woman, non-smoker, who complained of dry cough and dyspnea during the last month came to the emergency department due to increased dyspnea. The chest X -ray showed areas of poorly defined, bilateral alveolar opacities, leading to the diagnosis of bronchopneumonia with partial respiratory failure. During admission, she experienced an exacerbation of the dyspnea. A high-resolution computed tomography scan was performed, showing areas of ground glass opacities with interlobular septal thickening (“crazy-paving” pattern), predominantly in lower lobes. She required mechanical ventilation and was admitted to the intensive care unit. Subsequently, an open lung biopsy was performed. The following questions should be proposed: – Is it possible to make the diagnosis of organizing pneumonia (OP) only by clinical findings? – Are the imaging test findings pathognomonic? – Is a lung biopsy required to confirm the diagnosis of OP? – Is it necessary to wait for histologic confirmation to start treatment when OP is suspected?