Hypersensitivity Pneumonitis Flashcards
diagnostic hallmark of HP
IgG precipitating antibody on double gel diffusion plate
Headcheese sign can be seen it what stage of HP
Subacute
Headcheese
GGO, air trapping, mosaic perfusion
PFT of HP
restrictive
lung volume decreased
DLCO decreased
can be normal, obstructive and mixed
CD4 /cD8 in HP is
low
(normal is 1.8)
classic triad of subacute HP
interstitial lymphocytic-histiocytic CELL INFILTRATE
Bronchiolitis obliterans
non necrotizing granulomas
added to sugarcane to eliminate growth of organism responsible for Bagassosis
propionic acid
most important factor in HP prognosis
presence of fibrosis
in HP, compare lobes affected in HRCT findings in acute, subacute, chronic
acute: lower lobes
subacute and chronic:mid and upper
it is a th2 mediated hypersensitivity lung dx that affects Asthmatics and CF patients
Allergic Bronchopulmonary Aspergillosis
Minimum criteria of ABPA
worsening lung function
positive skin prick test
Total serum IgE >1000 ng/ml (416 IU/ml)
Increased Asp specific IgE and IgG antiBODIES
new pulmonary infiltrates
additional criteria in ABPA
central bronchiectasis
Mucus plugs (aspergillus containing)
blood eosinophilia >400
(not in steroids)
precipitating antibodies
High attenuation impaction is pathognomonic of
ABPA
In px with cystic fibrosis, aspergillosis has 4 classifications:
Class 1: non disease
2: serologic
3: sensitized
4: bronchitis
in ABPA, most common radio fx
large
homogenous shadow in one
upper lobe
no change in volume
fine parallel lines radiating from hila which can be seen in ABPA
tram line shadows
(inflammation of airway walls)
useful marker for disease activity of ABPA
IgE levels
management of ABPA
Prednisone
Itraconazole
Stages of ABPA
Stage 1 (acute)
Stage 2 remission - decline of Ige by 35%
Stage 3 Exacerbation - 2 fold inc in IgE
Stage 4 Corticosteroid dependednt
Stage 5 Fibrotic (severe upper lobe fibrosis), honeycombing
diagnosis of eosinophilia with hyphae is consistent with
ABPA
Male recently resume smoking may suffer from
acute eosinophilic pneumonia
in acute eos pneumonitis, main pathologic findings are
acute and organizing DAD
marked infiltration of eosinophil
ABSENT granulomata
in acute lung eos, peripheral blood eosinophilia is typically ________
absent
peripheral BLOOD eos
steroid duration in acute eos pna
8 weeks
middle aged female
non smoker
with Asthma
Chronic Eos pneumonia
