Interstitial lung disease Flashcards
What is interstitial lung disease?
Any disease process affecting the lung interstitium i.e. the alveoli and terminal bronchi.
What kind of pattern does this produce on spirometry?
Restrictive. FVC will be reduced.
What kind of hypersensitivity reaction is sarcoidosis?
Type 4 hypersensitivity
What does type 4 hypersensitivity mean?
Delayed-type reactions i.e. T-cell mediated
What characterises sarcoidosis?
Multi-system involvement
Non-caseating granulomas
Unknown aetiology
What are some of the features of acute sarcoidosis?
Erythema nodosum Uveitis Bilateral hilar lymphadenopathy Arthritis Fever
What are some of the features of chronic sarcoidosis?
Lung infiltrates i.e. alveolitis Skin infiltrations Peripheral lymphadenopathy Hypercalcaemia Multi-system involvement e.g. renal, myocardial, neurological
What are some differential diagnoses of sarcoidosis?
TB
Lymphoma
Carcinoma
Fungal infection
How is the diagnosis of sarcoidosis made?
CXR Bronchoscopy Biopsy CT Spirometry Blood test - calcium levels and inflammatory markers
What type of hypersensitivity reaction is extrinsic allergic alveolitis?
Type 3 hypersensitivity
What does type 3 hypersensitivity mean?
Immune complex mediated hypersensitivity i.e. involvement of antibodies
What kind of diseases does extrinsic allergic alveolitis include?
Bird fanciers lung
Malt workers lung
Farmers lung
What are some of the symptoms of acute extrinsic allergic alveolitis?
Cough Breathlessness Myalgia Pyrexia Hypoxia Crackles
When does the onset of symptoms of acute extrinsic allergic alveolitis tend to occur?
Several hours after exposure
What are some of the symptoms and signs of chronic extrinsic allergic alveolitis?
Progressive breathlessness and cough
Crackles
What abnormalities would you expect to see on CXR with suspected diagnosis of extrinsic allergic alveolitis?
Widespread pulmonary infiltrates/may have progressed to fibrosis, particularly in upper zones
Lung biopsy can be done if in doubt
What is the treatment for EAA?
Removal of antigen
Oxygen in acute exacerbation
Steroids
What is the clinical presentation of idiopathic pulmonary fibrosis?
Progressive breathlessness
Dry cough
Finger clubbing
Fine inspiratory crackles bilaterally
What abnormalities would you expect to see on CXR in suspected diagnosis of idiopathic pulmonary fibrosis?
Bilateral infiltrates
What kind of histological changes might you see in idiopathic pulmonary fibrosis?
Chronic inflammatory infiltrate i.e. neutrophils and fibrosis in alveolar walls and/or intra-alveolar macrophages
What treatment is available for idiopathic pulmonary fibrosis?
Lung transplant indicated for younger patients
Can idiopathic pulmonary fibrosis result in death?
Yes - death within roughly five years due to type 1 respiratory failure
What are some of the features of coal workers pneumoconiosis?
Initially just a CXR abnormality
Progressive massive fibrosis
Restrictive lung pattern
Breathlessness
What are (ex-)coal workers who smoke at particular risk of developing?
Chronic bronchitis
What is Caplan’s syndrome?
Rheumatoid pneumoconiosis
What is silicosis?
An interstitial lung disease which develops after 15-20 years exposure to quartz
Which workers are particularly at risk of developing silicosis?
Coal miners
Glass workers
Boiler workers
What is the characteristic appearance of silicosis on CXR?
“Egg-shell” appearance
What are some complications of chronic silicosis?
Progressive breathlessness
Restrictive lung pattern
Pulmonary fibrosis
