Diffuse Parenchymal Lung Disease

Question 1

What is interstitial lung disease?

Answer 1

Combination of interstitial inflammation, granulomatous inflamation or fibrosis

Question 2

What is the most common interstitial lung disease?

Answer 2

Idiopathic interstitial pneumonias

Question 3

Sx of interstitial lung disease

Answer 3

progressive dyspnoea or persistent, non-productive cough

Question 4

Ix of interstitial lung disease

Answer 4

CXR, high resolution CT: reticular, nodular or mixed patternsLung function test: restrictive pattern

Question 5

Cuases

Answer 5

• Drug induced - Environmental and occupation exposures: pneumoconiosis, hypersensitivity pneumonitis- Idiopathic interstitial pneumonia- Diffuse alveolar damage- Collage vascular disease and IBD- Primary or unclassified: e.g. sarcoidosis*, aspiration

Question 6

What is sarcoidosis

Answer 6

Most common interstitial lung diseaseCommonly presents as hilar lymphadenopathy w/ or w/out parenchymal infiltratesNon necrotising granulomatous inflammation, distributed along lymphatic pathways (bronchovascular bundles, interlobular septa and pleura)

Question 7

Most common age group of sarcoidosis

Answer 7

Affecting mostly young adults 20-40 yo

Question 8

Dx of sarcoidosis

Answer 8

Bilateral wedge biopsy - confirms disease presence- staging of diseaseDiagnosis of exclusion once granulomatous inflammation confirmed by biopsy (infection must be excluded clinically)

Question 9

How does sarcoid granulomatous inflammation from others?

Answer 9

Non-necrotising

Question 10

DDx of bilateral hilar enlargement

Answer 10

SarcoidosisLymphomaTBMetastatic carcinomaOther Infection: viral, fungal

Question 11

What is diffuse alveolar damage?

Answer 11

= acute respiratory distress syndrome causing acute lung injury (clinical term)

Question 12

Natural Hx of diffuse alveolar damage?

Answer 12

Acute onset (24-48 hours), require assisted ventilation50% of cases resolve with normal lung architecture, others may progress to end stage honeycomb lung (end stage fibrosis of lungs - does not suggest cause, end stage for all)

Question 13

Causes of diffuse alveolar damage?

Answer 13

Infection, trauma, aspiration, inhalation injury, drugs, radiation, idiopathic

Question 14

Complications of diffuse alveolar damage?

Answer 14

Develop respiratory failure, and pulmonary oedema

Question 15

Three phases of diffuse alveolar damage?

Answer 15

1: exudative (acute)2. organising3. fibrotic (chronic)

Question 16

What are the synonymous names for idiopathic interstitial lung disease?

Answer 16

Usual interstitial pneumoniaCryptogenic fibrosing alveolitis

Question 17

What is honeycomb lung?

Answer 17

Irreversible end-stage manifestation of a large number of intierstiial infalmaotyr and proliefative lung diseases

Question 18

Causes

Answer 18

Idiopathic xx

Question 19

Morphology

Answer 19

Cysts on background of xx

Question 20

Causes of pulmonary fibrosis

Answer 20

h