Localized Organizing (Round) Pneumonia

Lee A Fox, MD
Andetta R Hunsaker, MD

February 13, 1997

Presentation

A 41-year-old woman presented to the emergency department with fever and bibasilar rales.

Imaging Findings

Plain chest radiographs, PA and lateral views

Plain chest radiographs, 2 weeks later

Posteroanterior and lateral chest radiographs demonstrate a 4.5 cm round opacity (arrows) in the superior segment of the right lower lobe. The lungs are otherwise clear, and the costophrenic sulci are sharp.

Follow-up chest radiographs obtained two weeks later (following antibiotic treatment) demonstrate nearly complete resolution of the round mass (arrows).

Differential Diagnosis

neoplasm
localized inflammatory process

Diagnosis

Localized organizing (round) pneumonia

Discussion

Localized organizing (round) pneumonia is a pulmonary entity that can often be misinterpreted, both clinically and radiographically, as bronchogenic carcinoma of the lung. The process begins in a segmental bronchus and spreads through the lymphatic channels and the pores of Kohn (interalveolar communications) producing a spherical appearance. The disease involves mainly the small bronchi and alveoli. Multiple segments may be involved, but the interlobar septae usually confine the spread of disease to one lobe. Klebsiella, Streptococcus pneumoniae, and Mycobacterium tuberculosis are more often cultured from round pneumonias than other streptococcal or staphylococcal organisms.

The differentiation between round pneumonia and a neoplastic process is a very difficult diagnosis to make. A trial of antibiotics would clarify lung opacities caused infection as there is usually rapid improvement of symptoms with antibiotic therapy. Nevertheless, this delay in appropriate treatment may prove harmful in a patient with a malignancy. Clinical presentation may help with the diagnosis. Patients with round pneumonia often present with acute febrile illness and mild respiratory symptoms.

References

1. Greenfield H, Gyepes MT. Oval-shaped consolidation simulating new growth of the lung. American Journal of Roentgenology 1964; 91(1):125-129.

2. Ackerman LV, Elliott GV, Alanis M. Localized organizing pneumonia: Its resemblance to carcinoma. American Journal of Roentgenology 1954;71(6):988-996.

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