Bronchiolitis obliterans organizing pneumonia: experience at three hospitals in Riyadh

Because reports of bronchiolitis obliterans organizing pneumonia [BOOP] are lacking from the Middle East, we conducted a retrospective review of all histopathologically proven cases of BOOP over a 10-year period at three tertiary care hospitals in Riyadh and describe the clinical features and outcome. Charts at the three hospitals were searched using a specific code for BOOP or cryptogenic organizing pneumonia [COP]. Lung specimens had to show histological proof of BOOP with a compatible clinical picture. Chest radiographs and high-resolution CT scans were reviewed. Twenty cases of biopsy-proven BOOP had well-documented clinical and radiographic data. There were 11 males and 9 females [mean age, 58 years; range, 42-78]. The clinical presentation of BOOP was acute or subacute pneumonia-like illness with cough [85%], fever [70%] dyspnea, [85%] and crackles [80%]. The most frequent radiological pattern was a bilateral alveolar infiltrate. The most common abnormality on pulmonary function testing [n=14] was a restrictive pattern [11 patients]. Most patients [70%] had no underlying cause [idiopathic BOOP]. Other associations included thyroid cancer, rheumatoid arthritis, syphilis and Wegner's granulomatosis. Ten patients [50%] had a complete response to steroids, 6 [30%] had a partial response and 3 [15.8%] with secondary BOOP had rapid progressive respiratory failure and died. The clinical presentation of BOOP in our patients is similar to other reported series. A favorable outcome occurs in the majority of cases. However, BOOP may occasionally be associated with a poor prognosis, particularly when associated with an underlying disease

Cardiopulmonary exercise testing. an underutilized diagnostic tool in Saudi Arabia

To assess the use of cardiopulmonary exercise testing [CPET] in major hospitals and medical centers throughout the Kingdom of Saudi Arabia [KSA] and to seek information on the way CPET is conducted. Self-reported questionnaires on the use of CPET were mailed during the fall of 2002 to 54 major public and private hospitals and medical centers throughout the KSA. The response rate was 64.2%. The returned questionnaires were coded and data were analyzed. The findings indicated that more than 85% of the sample was not employing CPET in their medical centers. However, all of the surveyed centers were regularly performing stress electrocardiogram tests. Approximately 21% of those medical centers who did not have CPET are planning to have it in the near future. The most frequent reasons for not conducting CPET were lack of equipment, lack of trained technicians and lack of training in interpreting test results. Moreover, the most important reasons for conducting the CPET were pulmonary problems, followed by cardiac disorders. Treadmill and leg ergometer were used most as an exercise mode. Bruce protocol as well as institution specific protocols were equally used during CPET. Finally, there appears a lack of local cardiorespiratory data, especially for healthy Saudi females at all ages as well as older male group. Cardiopulmonary exercise testing as a diagnostic tool for cardiopulmonary diseases was extremely underutilized in Saudi hospitals and medical centers. Much greater efforts are needed to raise the awareness among physicians on the usefulness of CPET

Bronchiolitis obliterans organizing pneumonia

Bronchiolitis obliterans with organizing pneumonia BOOP is now established as a distinct clinicopathologic entity, yet it may be overlooked by clinicians due to unfamiliarity and its non-specific presentation. It can be either idiopathic or associated with a variety of causes, such as infections, drugs, radiation or connective tissue diseases. A lung biopsy is needed to provide histopathologic confirmation. Usually prognosis is good, and the response to steroids may be dramatic, but occasionally BOOP may be fatal or runs a chronic relapsing course. This article is an updated review on current knowledge regarding BOOP

Clinical spectrum of Swyer-James-Macleod syndrome in adults

The aim of this study is to describe the clinical and imaging features of Swyer-James-Macleod syndrome [SJMS] in 9 adults. We reviewed the charts of 9 patients diagnosed with SJMS at the King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia over a 10 year period. The patients mean age was 38.1 years; males were more affected than females [7:2]. Seven of the patients had symptoms referable to the chest and a similar number had compatible abnormalities on physical examination. The left lung was involved in all cases. Bronchiectasis was present in 7 [77.8%]. Eight patients who underwent pulmonary function tests had combined defects. Two patients demonstrated significant reversibility. All patients had a stable course over at least before a 3 year follow-up period. Swyer-James-Macleod syndrome has a diverse manifestations in adults and can mimic other pulmonary disorders, which may lead to incorrect diagnosis and inappropriate therapy. The course is generally a stable one

patient with hypoxemia and a normal chest radiograph

The case of a young patient with hypoxemia and a normal chest radiograph is presented in the form of a clinical quiz, followed by a discussion of the differential diagnosis, investigative methods and a brief review of the final diagnosis