Zhou Wei, Zhang Longyun, Xu Bin, Wang Chuanhai
Department of Ultrasound, Shengli Oilfield Central Hospital, Dongying, 257034, Shandong, China.
Department of Pathology, Shengli Oilfield Central Hospital, Dongying, 257034, Shandong, China.
Diagn Pathol. 2025 Apr 26;20(1):53. doi: 10.1186/s13000-025-01654-x.
This case report describes a patient with acute fibrinous and organising pneumonia (AFOP) presenting with mass-like imaging on chest computed tomography (CT), aiming to enhance clinical awareness of this rare disease.
A 66-year-old man presented with cough, sputum, chest tightness and weight loss persisting for 1 month. Chest X-ray revealed a space-occupying lesion in the left lung. Further CT imaging demonstrated irregular soft tissue masses in both the upper and lower lobes of the left lung. Although the imaging findings suggested lung cancer, the final pathological diagnosis confirmed AFOP. The patient was treated with methylprednisolone, resulting in substantial improvement of the upper lobe lesion, whereas the lower lobe lesion showed minimal response. Following the addition of mycophenolate mofetil, the lower lobe lesion decreased substantially. Multiple lung biopsies confirmed the diagnosis of AFOP, with no evidence of a malignant tumour.
Acute fibrinous and organising pneumonia presents with non-specific imaging findings, and when manifesting as a mass-like lesion, it may be misdiagnosed as lung cancer. Pathological examination remains essential for diagnosis. Close monitoring of the clinical response is crucial during treatment, and the treatment plan should be tailored to individual patient needs.
本病例报告描述了一名患有急性纤维素性机化性肺炎（AFOP）的患者，其胸部计算机断层扫描（CT）显示有肿块样影像，旨在提高对这种罕见疾病的临床认识。
一名66岁男性，出现咳嗽、咳痰、胸闷和体重减轻症状持续1个月。胸部X线显示左肺有占位性病变。进一步的CT成像显示左肺上叶和下叶均有不规则软组织肿块。尽管影像学表现提示肺癌，但最终病理诊断确诊为AFOP。患者接受甲泼尼龙治疗后，上叶病变有显著改善，而下叶病变反应极小。加用霉酚酸酯后，下叶病变明显缩小。多次肺活检确诊为AFOP，无恶性肿瘤证据。
急性纤维素性机化性肺炎表现为非特异性影像学表现，当表现为肿块样病变时，可能被误诊为肺癌。病理检查对于诊断仍然至关重要。治疗期间密切监测临床反应至关重要，治疗方案应根据患者个体需求制定。
