Interstitial Lung Disease Flashcards
What is the interstitium?
The lung interstitium is the space between the air sacs and the small blood vessels that surround the air sacs. It contains connective tissue. When you breathe, oxygen from the air passes through your air sacs and lung interstitium and into your blood.
What is the most common type of interstitial lung disease?
Idiopathic
What is the epidemiology of interstitial lung disease?
- Not well defined, diagnosis of exclusion
- Males slightly higher than females
- Increased risk with +FH
- Associated with occupational exposures and autoimmune diseases
What is the presentation of interstitial lung disease?
- Progressive exertional dyspnea (m/c)
- Dry cough
- May have Sx of autoimmune disease
- Can be asymptomatic
Less common Sx include pleuritic chest pain or hemoptysis
What are the physical exam findings of interstitial lung disease?
Non-specific PE findings include:
- Bibasilar crackles
- Clubbing
- PE consistent with pulmonary hypertension
- Tachypnea
- Reduced chest pain
What is the most important element of the work-up for interstitial lung disease?
Thorough history
- Occupation
- Family history
- PMH (connective tissue diseases, malignancy, rheum conditions)
What is the usual first line imaging in working-up interstitial lung disease?
CXR (supportive but not diagnostic)
What is the best imaging test for ILD?
High-resolution CT
What will PFT’s show in ILD?
Maybe normal early on, later ILD will show a restrictive pattern
What are some supportive CXR and CT findings of ILD?
Bronchiectisis (tram-track appearance)
Miliary pattern
Honeycombing
Kerley lines
Reticular or rediculonodular opacities
What is the goal of treatment for ILD?
Prevent/limit progression of fibrosis. Fibrosis is irreversible.
What are the pharmacological treatments for ILD?
- Prednisone
- Antifibrotic agents (idiopathic pulmonary fibrosis)
- Treat GERD
What is the only definitive treatment for refractory disease?
Lung transplant
What is the characteristic “usual interstitial pneumonia” pattern on imaging in idiopathic pulmonary fibrosis?
- Basilar reticular opacities
- Honeycombing
- Bronchiectasis (tram tracks)
What is the epidemiology of sarcoidosis?
- Systemic inflammatory disorder
- Incidence higher in black patients
- F > M
- Average age of dx 20-40s (second peak around 60)
