Fig. 8.

Organizing pneumonia. 49-year-old female with RA on etanercept presenting with chest heaviness and nonproductive cough. (a) Initial CT. Bilateral peribronchial and subpleural consolidation with associated architectural distortion and traction bronchiectasis, which did not improve with antibiotics. Bronchoscopy was negative for infection. Wedge biopsy was consistent with organizing pneumonia. (b) CT chest few months later. Significant worsening of disease correlating with patient's declining pulmonary function and respiratory failure.

Teaching point: Organizing pneumonia mimics pneumonia; hence, if the diagnosis is suspected clinically, prompt bronchoscopy should be performed to rule out infection before initiating steroids.