Interstitial Lung Disease Flashcards
What are diffuse parenchymal lung diseases?
DPLD is a heterogenous group of clinical entities that share the following features :
1. Dyspnoea
2. Hypoxia
3. Restrictive ventilatory defect
4. Presence of bilateral infiltrates on CXR
Note: affects the interstitium, alveolar space and sometimes the airways
Known causes of DPLD?
- infections
- occupational/environmental
- drugs
- neoplasia
- systemic disease
- radiation
Infectious causes of DPLD?
- Viral : Measles, HSV, VZV
- Bacterial : Mycoplasma, Legionella
- Miliary TB
- Fungal : Aspergillosis, PCP, Histoplasmosis
- Parasites : Toxo, Schistosomiasis
Occupational/environmental causes of DPLD?
- Inorganic dusts : Silica, Asbestos, Carbon
- Organic dusts : Pigeon, Budgie HP/EAA
- Fumes : SO2, CL2, NO2
Drug causes of DPLD?
- Antibiotics : Sulphas, Nitrofurantoin
- Cytotoxics : Bleomycin, MTX
- Amiodarone, phenytion, gold
Neoplasia causes of DPLD?
1˚ - broncho alveolar carcinoma
2˚ - lymphangitis carcinomatosa
Systemic disease causes of DPLD?
- Cardiac : LVF, MS
- Renal : Uraemia and fluid overload
Idiopathic interstitial pneumonias?
- idiopathic pulmonary fibrosis
- desquamative interstitial pneumonia
- acute interstitial pneumonia
- non-specific interstitial pneumonia
- respiratory bronchiolitis interstitial lung disease
- cryptogenic organizing pneumonia
- lymphocytic interstitial pneumonia
Causes of Granulomatous DPLD?
- Sarcoidosis
- Berryliosis
- Lymphoma
- EAA
- TB
- Fungal infection
- Histiocytosis X
Causes of other forms of DPLD?
- Pulmonary Eiosinophilia(AEP, CEP)
- Collagen Vas Diseases (Scl, SLE, RA)
- Idiopathic Pulmonary Haemosiderosis
- Vasculitides : WG, Churg-Strauss
- Goodpasture’s syndrome
- Histiocytosis X / Langerhans cell granulomatosis / EG
- Lymphangioleiomyomatosis(LAM)
- Congenital : Neurofibromatosis, Tuberous sclerosis
- Amyloidosis
- Ankylosing spondylitis
- Liver disease
Approach to DPLD?
- Thorough History
- Thorough Physical Examination
- Lung Function Test
- CXR
- Bloods, Sputum, Urine, ECG, Echo
- HRCT
- Bronchoscopy (BAL/Transbronchial biopsy)
- OLB / VATS
History taking in DPLD?
Detailed medical, occupational ,hobby, drug & family histories
Symptoms of DPLD?
SOB and cough (dry in most cases)
Social history?
Rural background + indoor fossil fuel cooking in unventilated hut and maize-grinding > “Hut Lung”
Environmental/occupational history?
- Exposure to inorganic dusts > pneumoconioses
- Exposure to organic dusts(eg. birds) > EAA
