Dubin Interstital Lung Disease Flashcards
Acute interstitial Pneumonia v. Idiopathic interstitial Fibrosis
Acute - fast onset (within 7 days)
Idiopathic - progression over a year
50yo with increasing DOE over the past year. Clubbing CXR shows diffuse linear opacities. HRCT shows bilateral abnormalities. Abn PFTs.
Idiopathic interstitial Fibrosis
50yo with acute dyspnea. 7 days of dry cough, SOB, fever, malaise. ABG: pH7.30, PaCO2 65, PaO2 55 on 100% O2. CXR - ground glass, septal thickening.
Acute interstitial Pneumonia
Pathogenesis of Drug Induced Pulmonary Injury - name of injury.
- AMIODARONE results in Acute Interstitial Pneumonitis (also, Organizing Pneumonia, ARDS, Hypersensitivity pneumonia)
- Methotrexate results in interstitial fibrosis
Lipid-laden foamy alveolar macrophages are caused by what @ what dose?
Amiodarone, (over 400mg/day)
Loosely formed, noncaseating epithelioid cell granulomas in interstitium indicative of what?
Hypersensitivity pneumonitis
CXR - (centrilobular) focal patchy consolidation or diffuse ground glass appearance
Acute hypersensitivity pneumonitis
Dx and pathogenesis:
Pet shop owner has EPISODIC (every 4wks for past 6mo) coughing attacks, SOB, recurrent fever.
Hypersensitivity pneumonitis: Bird Fancier’s Lung - IgG mediated hypersensitivity due to exposure to feathers and bird droppings.
- episodic
PFTs in Hypersensitivity pneumonitis
FEV1/FVC increased
FVC reduced
35yo dairy farmer, never smoked, presents with wheezing, mild decrease in FEV1, decreased FVC. CXR normal. Labs reveal eosinophilia and clusters of eosinophils in sputum.
Bronchial asthma - IgE and eosinophilia.
- NOT episodic
22yo sheep and turkey farmer. Episodic periods of wheezing, dyspnea, low grade fever of 100F. Serum precipitans with fungus.
Hypersensitivity Pneumonitis: Farmer’s Lung - IgE and IgG, Type 3
- episodic, fever
What do serum precipitans indicate?
Type 3 hypersensitivity reaction.
Thermophilic actinomycetes, think what?
Farmer’s lung
Bilateral infiltrates, think what?
Farmer’s lung
Describe Silo Filler’s lung
Respiratory distress due to nitric oxide in grain filled silos
SANDBLASTER, foundry worker, granite worker
Silicosis
CXR: bilateral Eggshell calcifications.
In what regions?
Silicosis - in hilar and mediastinal regions
75yoM with severe dyspnea for a year. No weightloss, chest pain, cough, or hemoptysis. 50 pack year hx. Foundry worker.
Always do what after this diagnosis? Why?
Silicosis
- ALWAYS administer PPD test because TB is increased by 30(?) in silicosis pts
What is a postive PPD test in silicosis pt?
10+mm
TB is increased by
35yoM with PMG of RA. Treated with gold injections, methotrexate, and aspirin. CXR shows multiple calcified pulmonary nodules in both lungs. Dx?
Caplan’s Syndrome = RA + smooth pulmonary nodules.
CXR: Localized pleural fibrous plaques/opacities
asbestosis
ferruginous bodies, mesothelioma
asbestosis
Occupation: autofactory worker, house builder, shipyard worker
asbestosis
47yo roofer and wife of roofer with a 30 pack year hx. Chronic, non-productive cough, DOE. CXR shows thickened, calcified opacities in lateral chest wall and under diaphragm. Clubbing
Asbestosis - can be secondary!
Describe ferruginous bodies
Brown fusiform rods with translucent center with iron-containing material.
CXR: pleural thickening and possible pleural effusion in a shipyard worker who smokes.
Malignant mesothelioma
Coalescence of particles containing macules that form discrete areas of interstitial fibrosis, causing distention of resp bronchioles, forming areas of emphysema.
Coal Worker’s Pneumoconiosis
Prolonged expiratory phase and miner occupation.
Coal Worker’s Pneumoconiosis
Nuclear technician moved to Fort Worth. 35yo DOE, dry cough, anorexia, night sweats. Bilateral lymphadenopathy. Sarcoidosis, but no anergy, no elevated ACE, so look for what with what test?
Berylliosis with beryllium lyphocyte proliferation test.
anti-glomerular basement membrane
Goodpastures
Symptoms in Goodpastures
Hemoptysis, hematuria.
Fibrosis secondary to anti-GBM
- NO URT problems
Two alveolar filling disorders.
Goodpastures, Chronic Eosinophilic Pneumonia
Systemic necrotizing granulomatous inflammation in URT as chronic rhinitis or sinusistis, gingival hyperplasia, or serous otitis media.
CXR: multiple nodular or cavitating infiltrates or ulcerative lesions
Wegner’s
Three important Wegner’s associations.
- C-ANCA
- Hematuria
- Upper respiratory problem (*differentiates from Goodpastures)
P-ANCA
Churg Strauss
Necrotizing vasculitis in URT and LRT, preceded by allergic disorders.
- abdominal pain
Churg Strauss
Three phases of Churg Strauss
- Allergic stage - Frequent allergic rhinitis/sinusitis
- Eosinophilc Stage - Asthma and IgE
- Vasculitic Syndrome - erythematous maculopapules
CXR: bilateral patchy infiltrates
Churg Strauss
Kevim, serum Ca, serum ACE tests for what?
Sarcoidosis
Associations of sarcoidosis.
- Elevated ACE
- Hypercalciuria, hypercalcemia
- Anergy
- Erythema Nodosum
- Noncaseating granulomas
- Bilateral hilar lymphadenoapthy (HRCT=possibly see fibrosis or alveolitis)
- Decreaed DLCO
Treatment for sarcoidosis
- Short term, high dose steroids (but NOT INHALED) - sarcoidosis is a systemic disease
transbronchial lymphoid biopsy used for what?
Sarcoidosis
Quantiferron Gold test used for what?
Immigrants who have received TB vaccine with positive PPD, to determine if they actually need TB therapy.
Acute form of Sarcoidosis is called what and what are the three acute presentations?
Lofgren Syndrome:
- Hilar adenopathy
- Erythema Nodosum
- Arthritis (men); fever (women)
What four things comprise of Heerfodt’s syndrome?
Unveoparotid fever -
- Uveitis
- Parotid gland involvement
- Fever
- Possible facial nerve
Differential for cavitary lung lesions.
CAVITY: Carcinoma - squamous cell, melanoma, cervical, sarcoma metastasis Autoimmune - Wegner's, Rheumatoid Lung Vascular - bland/septic emboli Infection - TB, fungal, bacterial Trauma Young
68yoM with SOB increasing for 2 years. PMH includes psoriasis, taking methotrexate to treat. PFT’s reduced, FEV1/FVC 95+%.
Methotrexate induced interstital fibrosis
JVD, murmur increases with inspiration, pulse ox reveals desat with exercise. V/Q normal. 22yo.
What is this and what tx?
Primary pulmonary HTN.
R-hearted catheter
Obese person, falls asleep easily throughout the day, has obstructive sleep apnea.
Pickwickian Syndrome
