Interstitial lung disease Flashcards
How is NSIP pattern different? Radiologically and clinical implications?
Still basal predominant but ground glass without evidence of honeycombing
Look CAREFULLY for underlying CTD
Often responds to steroids.
What is cryptogenic organising pneumonia? Radiologically what is specific about it?
Idiopathic form of bronchiolitis obliterans organisim pneumonia which could be caused by ID, CTD, drugs
See someone who look slike they had CAP but then the sx keep going for 6-8 weeks
SEE PERIPHERAL PREDOMINANCE IN HALF
Good prognosis with steroid response
What are the three interstitial smoking related lung diseases?
Respiratory bronchiolitis assoc ILD (centrilobular microlobular disease)
Desquamative interstitial pneumonia (Micronodular disease with ground glass all over)
Pulmonary langerhan cell histiocytosis (upper one cysts and nodules)
Subacute progressive cough and dyspnoea
Most common lung problem in RA?
Pleural involvement most common
Rheumatoid nodules
ILD- UIP worse prognosis- also see NSIP, BOOP
Isolated pulmonary hypertension
Methotrexate, leflunomide effects
pLAM is another diffuse lung disease- what do the effusions look like?
Often this disorder presents with a pneumothorax in premenopausal women or chylous effusion- ddx lymphoma
Due to an inactivating mutation of TSC gene causing activation of mTOR. Reccurs post transplant.
Can also have renal angiomyolipomas which rarely transform to sarcomas
Related to tuberous sclerosis
What are the seven idiopathic intersitial pneumonias?
NSIP UIP AIP COP LIP DIP RB assoc ILD
One sentence about NSIP
Do better than UIP, have relative subpleural sparing, NO HONEYCOMBING, no fibroblastic foci and temporally uniform on biopsy, more steroid responsive, more likely to be the one you see in scleroderma lung
UIP one sentence
The classic middle aged male smoker, histo shows temporally all different with fibroblastic foci, honeycombing, the dominant RA pattern
AIP one sentence
pathological equivalent of ARDS, 50% mortality, hyaline membranes on histo
COP one sentence
good prognosis, subpleural fibrosi with ground glass and nodules, often postinfective after IV abx but keep being sick. Can be assoc with CTD but then its BOOP as no longer cryptogenic
One sentence LIP
seen in women
DSIP
smoking asssociated, the end stage of RB-ILD, no honeycombing or fibrosis just lower lobe infiltrates, loads of macrophages in alveoli
RB-assoc ILD one sentence
Reticular lung changes, mosaic obstruction small airways
Whats the cut off for transplant referral?
DLCO 40% or below refer if appropriate
Three drugs that induce parenchymal lung disease?
Amiodarone- such a long half life that stopping drug rarely allows improvement
Methotrexate- good prognosis if stop drugs
Nitrofurantoin- CXR looks like failure in acute form
