Interstitial Lung Disease Flashcards
what is pneumoconoiosis? what are some explains of disease which fall under this category
pneumoconoiosis - group of lung diseases which result from inhaling inorganic dusts –> resulting in chronic fiberosis of the lung
- asbestosis
- silicosis
- coal/coal dust
- beryllium
Parynchymal Asbestosis
what is it
when do you usually see it
what type of expsoures
- a restrictive disease of the lungs diffuse and resulting in fiberosis
- impairs gas exchange
- progressive exercision on dyspnea
changes appear on radiography > 10 years after exposure (lays ** dormant for 2-=40 years**)
who is exposed
- ship workers
- mechanincs
- construction
- military
- people whos homes may have asbestos
- household contacts of these workers
- secondary exposures in the workplace
what are the signs and symptoms of asbestosis?
whats seen on chest xray
- dyspnea
- crackles
- cyanosis
- clubbing
chest xray
- thickened pleura
- calcified pleural plaques
- interstitial fibrosis
- “Shaggy heart sign
- normally below hilum and lower you will see these things
what are some abnormalities with asbestosis
- things youll see on xray
- pleural plauques
- thickened pleura
- atelectasis
- benign pleural effusions
what is silicosis? who is at risk? length of exposure? what are they at increased risk for?
silicosis: inhalation of silica
from..
- stone workers
- mining
- glass cutters
- cemeting
if expousre is intense –> dont need large periods of exposure
if small –> can be subtle accumulation
at an increased risk of TB!!!
what are some radiographic findings for silicosis?
- diffuse throughout the lung : see opacities
- **miliary infiltrations (small dots) or consolidation
- eggshell calcifications!**
normally begins in the upper lobes
how is silicosis diagnosed and treated?
diagnosis
- history of significant exposure
- consisten imaging
- excluded other causes of symptoms
- biopsy rarely needed
treatment
- symptomatic: bronchodialotors, abx. if infected, O2 for hypoxia
- transplant if severe
coal workers pneumonitis
what is it
who gets it
what do you see on xray
- deposition of coal mine dust in lungs
- silicosis can be concurrent infection
- upper lung fields effected
- ** WILL LOOK IDENTICAL ON IMAGE AS SILICOSIS MINUS EGGSHELL APPEARACE**
- smoking makes it worse
- no treatment
berylliosis
what is it
who gets it
complications
testing
imaging
- heavy metal poisoning due to inhaled beryllium dust
- who: those who work in aeorspcae or light bulb high tech
- complications: acute syndrome, chronic granulomatous, lung fiberosis, cancer
test: with a beryllium lymphocyte test
imaging: show nodules along septal lines
Occupational Asthma
- what triggers
- how to dx.
- treatment
triggers
- grain/wood dust
- tobacco
-pollen
-dyes
-formaldehyde
dx: spirometry before and after exposure needed for dx.
treat: bronchodilators
industrial bronchitis and byssinosis
what is it
who gets in
symptoms
- miners most common get industrial bronchitis
- cotton dust is byssinosis
- like asthma –> chest tightness, dyspnea, and repeated exposure –> chronic bronchitis
hypersensitivity pneumonitis
-what is it
- pathology
- seen on bx.
- inflammation of the alveoli and airways (without bronchospasms)
- an immune mediated reaction to an inhaled antigen
- bird droppings !!! and pets!! animals!! - essentially an allergic reaction in the lungs to an inhaled thing
bx: granulomas
etiologies for hypersensitivity pneumonititis
subtypes (based on time)
- moldy hay
- birds
- grain dust
- air conditioning
- coffee dust
- cheese workers
subtypes
acute: within 48 hrs. of exposure; ground-glass opacities
subacute: weeks after
chornic: can lead to ILD
treatment of hypersensitivty pneumonitis
- allergey avoidance
- steroids if severe attack
what is interstitial lung disease?
what can it be a result of (generally)
what is the most commony type
- a GROUP of diseases characterized by the progressive, diffuse fiberosis and inflammation of the lungs (starting usually in intersitium and then impacting the capillaries, alveoli and gas exchange)
- impacts the airways, vasculature and pleura
- many types of disease can cause ILD –> MCC is idiopathic plumonary fiberosis
what is the gold standard diagnosis for ILD?
- pulmonary pathology specimens (BIOPOSY)
- but dx. is often made without as it wont change treatment
what are some physiological problems which can result from inflammation and fiberosis of ILD?
- reduced elasticity = stiffened lungs
- reduced lung capacity (compliance)
- gas exchange issues
larger airways usually not affected! since theres no “obstruction”
what are some radiographic findings you may see on ILD?
- thickened interstitum
- ** honeycombing of the lungs –> seen in fiberosis
- traction bronchiectisis (large airspaces of airways)
when doing a workup for ILD – what are some key things to be aware of/ask
- through hsitory!! about everything
- PE may be normal respiratory problems –> look for extrapulmonary signs of other disease processes
- the goal is to find the underlying conditions and etiologies of ILD!
what are some causes (etiology) of ILD
Exposures
- smoking
- occupational (asbesosis and silica)
- radiation
medications
- methotrexate
- amioderone
- sulfonamides
- chemos
- heroin, cocain and crack (talc)
connective tissue disease
- RA
- scleroedema
- SLE
Idiopathic fiberosis
granulomatous
histological (idopathic)
- LAM
- PLCH
- PAP
-PPF
-sarcoidosis
infection
-coccidyomycosis
-histoplasmosis
specifics of the idopathic interstitial penumonias of ILD (7 subtypes)
UIP: think > 65, fiberosis
AIP: acute, very sick, emerpic abx & steroids, high mortality
NSIPS: NON-smokers + connective tissue dz.
RB-ILD: SMOKING
COP: weeks after flu-like, DENSE infiltrates, GET BETTER WITH STEROIDS
specificas about idopathic fiberosis of ILD
- fibrosis, diffuse
- men > women
- clubbing!!
- acute exacerbations = steroids to help
- ## not a great prognosis
sarcoidosis and ILD
- non-caseating granulomatous inflammation –> therefore inflammation not tissue destruction
- blacks> whites
- NO CRACKLES
- skin involvement, lungs can be asymptomatic
- bilateral hilar LAN, reticular in apex of lung
treatment
- STEROIDS = 1st line
- methotrexate and TNF
-
Wegener Granulomatosis
- cavitary necrotizing and non-caseating granulomas at the arteries and veins
- BAL or VATS to get bx.
