Pneumopathie organisée secondaire à une hernie hiatale

Organizing pneumonia secondary to a hiatal hernia is a specific kind of inflammatory and fibroproliferative lung reaction due to a pulmonary aggression involving micro-inhalation of the digestive contents. The authors report the case of a 74-year-old woman presenting pneumonia of infectious speed, resistant to a triple antibiotic treatment. Clinically, her general condition changed and associated cough, fever, dirty sputum and dyspnoea. The bacteriological and immunological tests were normal. The respiratory functional explorations showed a moderate restrictive syndrome and hypoxemia. The broncho-alveolar wash found a mixed alveolite of predominantly lymphocyte and polynuclear neutrophiles. The thoracic scanner detected pleural alveolar opaqueness with the characteristic of organizing pneumonia as well as a voluminous hiatal hernia discovered by chance. No lung samples were taken because of a precarious general state of the patient and the respiratory instability. The strong corticosensitivity to the corticosteroid therapy backed up the authors' diagnostic hypothesis. The clinical and radiological evolution was good after six months of treatment. The patient benefited from a medical and then surgical treatment with a good evolution and without any recurrence.