ILD Flashcards
clinical presentation of ILD
progressive DOE, NONPRODUCTIVE cough, NO wheezing and chest pain
PE of ILD
crackles, inspiratory squeaks, cor pulmonale , cyanosis and clubbing (advance dz)
CXR od ILD
- ground glass (early)
- reticular netlike /micronodular pattern
- honeycombing (late)
most common CXR finding in ILD
bilateral reticular netlike opacities
pulmonary function test for ILD
restrictive defect
restrictive defect
decreased TLC, decreased FEV1 and FVC, nl or increased FEV1/FVC ratio
obstructive defect
increased TLC, nl FVC, decreased FEV1/FVC ratio
DLCO
diffusing capacity (reduced in ILD)
ABG
arterial blood gas (nl, hypoxemia, alkalosis in ILD)
bronchoalveolar lavage
minor extension of bronchoscopy allows for cellular analysis
gold standard for dx of ILD
lung biopsy
types of lung biopsy
fibroptic bronchoscopy w/transbronchial lung biopsy, thoracoscopy, open lung
complications of ILD
pulm HTN, cor pulmonale ( RVH), HF, Pneumothorax, CA
most common cause of 2nd pneumothorax
ILD
pneumoconiosis
any dz of the respiratory due to inhalation of dust particles
asbestos are linked to
bronchogenic CA and malignant mesothelioma
mesothelioma is always a/w
asbestos (most common in pleura)
Asbestosis
gradual onset, DOE, inspiratory crackles, clubbing, dry cough
CXR of asbestosis
opacities in lower lungs, thickened pleura, pleural plaques
PFTs of asbestosis
restrictive pattern
al asbestosis
Male, 50ish, pipefitter, smoker, pleural plaques
lung damage is asbestosis is
irreversible
asbestosis + smoking
lung CA x 59
silicosis classification
chronic : simple or complicated
chronic simple silicosis
hilar node calcification (eggshell pattern), small round opacities (silicotic nodules)
chronic complicated silicosis
progresses after eliminated exposure : tachypnea and prolonged expiration
Sam Silicosis
male, miner, indeterminate age, smoker, eggshell calcification
sam silicosis has elevated risk of ?
TB
sarcoidosis
multisystem inflammatory dz with unknown etiology
noncaseating granulomas a/w
sarcoidosis
PE of sarcoidosis
fever, anorexia, arthralgias, DOE, cough, erythema nodusum
erythema nodusum a/w
sarcoidosis
sarcoidosis PFTs
restrictive
CXR of sarcoidosis
bilateral symmetric hilar and right paratracheal mediastinal adenopathy (most common pattern)
sarcoidosis lab findings
hyperCa, high ESR, high serum protein, elevated ACE in 60%
elevated serum ACE
sarcoidosis
sally Sarcoidosis
female, african american, 30ish, non-smoker, hilar adenopathy, she is an ACE
wegener’s granulomatosis
immune mediated systemic vasculitis, glomeroulonephritis
75% of these pt have renal involvement
wegener’s granulomatosis
rhinorrhea with purulent/bloody nasal discharge
wegener’s granulomatosis
PFT shows both obstructive and restrictive pattern
wegener’s granulomatosis
CT findings of wegener’s granulomatosis
irregular and stellate-shaped peripheral pulmonary arteries (vasculitis sign)
lab findings of wegener’s granulomatosis
elevated ESR, leukocytosis, thrombocytosis, cormocytic anemia, elevated BUN/Cr, + ANCA
positive ANCA a/w
wegener’s granulomatosis
Will wegener’s granulomatosis
male or female, 40-50ish, upper airway symptoms √ the nose, goes to AA (+ANCA), vasculitis, renal
most common of 7 idiopathic interstitial pneumonias
idiopathic pulmonary fibrosis (IPF)
Dx of IPF
after excluding other causes of ILD
digital clubbing is seen in 20-50% of
IPF
CXR of IPF
bilateral diffuse reticular or reticulonodular infiltrates, periphery and bases
patchy basilar infiltrates
HRCT of IPF
PFTs of IPF
restrictive
dx of IPF
lung biopsy
Ivan IPF
male, 60ish, a common man, smoker
most common indication for lung transplant
IPF