From the Guidelines
Migratory pulmonary infiltrates are characterized by temporary and recurrent opacities on chest imaging that shift from one area of the lung to another, often associated with conditions like idiopathic bronchiolitis obliterans with organizing pneumonia (idiopathic BOOP) 1. These infiltrates can be a manifestation of various diseases, including idiopathic BOOP, which is a clinicopathological syndrome of unknown etiology, typically affecting individuals in their fifth and sixth decade of life 1. The symptoms of migratory pulmonary infiltrates may include cough, fever, malaise, fatigue, and weight loss, with inspiratory crackles frequently present on chest examination 1. Key features of idiopathic BOOP include a uniform, recent temporal appearance to the changes, patchy and peribronchiolar distribution, and the presence of foamy macrophages in the alveolar spaces 1. The diagnosis of migratory pulmonary infiltrates often involves serial chest X-rays or CT scans to document the migration pattern, along with routine laboratory studies, although these may be nonspecific 1. Treatment of idiopathic BOOP, a condition characterized by migratory pulmonary infiltrates, typically involves corticosteroid therapy, which results in clinical recovery in two-thirds of the patients 1. Some of the key radiographic features of migratory pulmonary infiltrates in the context of idiopathic BOOP include bilateral, diffuse alveolar opacities, a peripheral distribution of the opacities, and patchy airspace consolidation on HRCT scans 1. The migratory nature of these infiltrates is crucial for distinguishing them from other lung pathologies, such as bacterial pneumonia or malignancy, which tend to have more fixed presentations 1. In clinical practice, the management of migratory pulmonary infiltrates should prioritize the identification and treatment of the underlying cause, with corticosteroids being a common therapeutic approach for reducing inflammation in conditions like idiopathic BOOP 1.
From the Research
Definition and Characteristics
- Migratory pulmonary infiltrates (PMI) are observed in a few diseases, including Mycoplasma pneumonia (Mp) infection 2, and are characterized by fleeting and/or relapses of patchy opacification or infiltrates of parenchyma throughout the whole lung field.
- The condition can present with unilateral alveolo-interstitial infiltrates, as seen in a patient with rheumatoid arthritis 3.
- Histopathological findings may show polypoid plugs of fibroblastic tissue filling and obliterating small airways and interstitial infiltrates of mononuclear inflammatory cells in the vicinal alveolar septa 2.
Associated Conditions
- PMI can be attributed to various conditions, including:
Diagnosis and Treatment
- Diagnosis can be supported by step sectioning of transbronchial biopsy specimens, which may show granulation tissue plugs within respiratory bronchioles or eosinophilic infiltration 4.
- Treatment may involve antibiotics, such as azithromycin, for Mp infection 2, or steroids and discontinuation of potentially causative medications, such as sulfasalazine or celecoxib, in cases of adverse reactions 3.