Diffuse and Interstitial Lung Disease Flashcards
Diffuse vs interstitial
Diffuse - involving parenchyma of both lungs
interstitial - diffuse lung dz that preferntially involves lung interstitium
Lung is either sole organ or might be part of multisystem
Ground glass opacification
Airspace filling less dense than consolidation
Alveolitis
Edema
Alveolar hemorrhage
Alveolar proteinosis
When to think of
Pneumocysttis
Alveolar hemorrhage
Fever, HIV risk
Hemoptysis
Ground glass
Reticular pathology
Alveolitis (after infectious pnuemonia, edema, hemorrhage and alveolar proteinosis excluded)
Collagen deposition/intersitital inflammation/interstitial edema/lymphatic process
Small nodules
Honeycomb
Traction bronchiec
Granuloamtous inflammation/infection/inhaled dust/neoplastic spread
End-stage lung fibrosis
Sarcoidosis
DIP
Alveolar proteinosis
Patho findings
Non-necortizing, well-formed granulomas…expect nodules
Desquam interstitial pneumonitis…ground glass opacities by imaging
PAS material filling alveolar without cells
IPF
Age, mutation, radio, patho
50s
Telomerase gene mutation (familal version)
Basilar, sub-pleural predominant reticular infiltrates
No associated PE or thoracic LN enlargement
Low titer ANA and RF may be present
Heterogeneity in extent and appartent age of lesions with little inflammation
IPF dx
Typical presentation and HRCT OR surgivcal biopsy
Asbestosis dx
Similar to IPF but with a plaque
Rheumatoid contrasted with IPF, HP, silicosis
Will have extra-pulm findings
Chronic HP will be upper lobe involvement
Silicosis is nodular and upper-lung
Pneumoconiosis
Respirable particles must be small enough to reach alveoli but large enough to not be breathed out
Most spherical except asbesots fibers
Look for ferruginous bodies in asbestos
Patho of silocosis vs. sarcoidosis, vs coal miners
All going to be upper lobe predominant
Carbon laden macrophages - CWP
Silicotic nodules - silliociss
Sarcoidosis - well-formed granuloma with multinucleated giant cells
Silicosis and CWP similarities and differences
Upper and mid zone predom nodular infiltrates
Simple and PMF varieites
Thoracic adenopathy may calcify
Diffs***
Silicotic nodule vs. macule
Silica polarizble
Silica has acute varient that mimics alveolar proteinosis
Asbestosis
Lower zone reticular infiltrates (mimics IPF)
NO adenopathy
PLeural plaques
Ferruginous bodies
Pneumonoconiosis dx by
Appropritate hx and imaging (maybe with path)
Sarcoidosis including dx
MULTIsystem disorder by non-caseating granulomatous infalmmation
Mimicked by berylliosis
dx - demonstration of non-caseating granulomas in 2 or more organs…exclude other dx
Will be nodular
May get hilar adenopathy
COP Path
Hx
Dx
Exuberant lung repair occurring in response to insult
Very important clinical hx - cough, dyspnea, fever of weeks-months
Recognitionf of syndrome as less acute than bacterial, evaluating potnetial predisposing condiions, characteristic lung patho, negative cultures
Alveolar hemorrhage syndromes
Hemoptysis with dyspnea
Urinalysis shows RBCs
Bilateral symmteric aispace filling (GGO)
Patho shows diffuse capillaritis
GPA - diagnositc is ANCA (proteinase 3)
Anti-glomerular basement membrane antibody disease - GBM antibody (cross reacts with alveolar basement membrane)…has linear glomerular distribtuion of IgG
Both are pulm-renal syndromes
Alveolar proteinosis
Chronic, non-infectious airspace opacities
Antibody to GM-CSF leads to excess surfactant production
SLowly progressive dyspnea and cough
IMaging is bilateral airspace opac with crazy paving
Dx by lavage or biopsy (PAS)
Therapy is whole-lung lavage plus GM-CSF
Goodpastures vs. GPA
Goodpastures has no ENT findings (or findings outside of the pulm-renal system)
HP is
Parenchymal lung dz resulting from inhlaation of an antigen to which pt has been previously sensitized
Patho of HP
Inhlaed antigen stimulates TLR (Th1 and Th17)
Smoking and ILD
SMokers get - respiratory bronchioltis - ILD
Desquamative interstitial pneumonia
Langerhands
Non-smokers get - HP and sarcoidosis…difference is that sarcoisosi does NOT have crackles
Acute
SUbactue
Chronic HP
Acute- non-specific bilateral airspace dxz with ground glass
Subactue- ground glass, centrilobular nodules, mosaic
Chronic - looks like IPF
