Organizing pneumonia-like pattern in COVID-19

Organizing pneumonia (OP) is a radio-histologic pattern that forms in response to lung damage in patients with focal or diffuse lung injury. OP is frequently observed subsequent to viral-induced lung damage and is associated with a diverse range of clinical outcomes.

We included 210 patients (mean age: 55.8 ± 16.5 years old; 61% male) with mild Coronavirus disease 2019 (COVID-19) who underwent chest computed tomography (CT) from 25 February to 22 April, 2020. The patients were divided into two groups based on the presence (n = 103) or absence of typical OP-like pattern (n =107) on initial chest CT. The extent of lung involvement and final outcome was compared across the two groups. Serial changes in imaging were also evaluated in 36 patients in the OP-group with a second CT scan.

Duration from symptom onset to presentation was significantly higher in the OP group (7.07 ± 3.71 versus 6.13 ± 4.96 days, p = 0.008). A higher COVID-19-related mortality rate was observed among patients with OP-like pattern (17.5% vs 3.7%, p = 0.001).There was no significant difference in the overall involvement of the lungs (p = 0.358), but lower lobes were significantly more affected in the OP group (p < 0.001). Of the 36 patients with follow-up imaging (mean duration of follow-up = 8.3 ± 2.1 days), progression of infiltration was seen in more than 61% of patients while lesions had resolved in only 22.2% of cases.

Our observation indicates that physicians should carefully monitor for the presence of OP-like pattern on initial CT as it is associated with a poor outcome. Furthermore, we recommend interval CT to evaluate the progression of infiltrations in these patients.