Interstitial Lung Disease Flashcards
Interstitial Lung Disease
Umbrella term for a number of conditions which cause scarring and inflammation of alveolar wall
ILD examples
Idiopathic Pulmonary Fibrosis
Drug Induced Pulmonary Fibrosis
Sarcoidosis
Extrinsic Allergic Alveolitis (EAA)
Connective Tissue Diseases
SLE and RA patients can develop ILD
Acute Presentation of Sarcoidosis (= Lofgren’s Syndrome)
Triad:
- Fever
- Arthralgia
- Erythema Nodosum
Lofgren’s Syndrome management
CXR - bilateral hilar lymphadenopathy
Should settle with NSAIDs
Repeat CXR in 3 months
Erythema Nodosum
Rash on ankles and around legs
Sarcoidosis bloods
Hypercalcaemia
Raised ACE
Raised ESR
Sarcoidosis = non-caseating granulomas.
Macrophages increase conversion of Vitamin D to active form.
Acute Sarcoidosis (Lofgren’s) common among
More common in:
Women
Afro Caribbean, Irish, Scandinavian
Sarcoidosis CXR
A chest x-ray may show the following changes:
Stage 0 = normal
Stage 1 = bilateral hilar lymphadenopathy (BHL)
Stage 2 = BHL + interstitial infiltrates
Stage 3 = diffuse interstitial infiltrates only
Stage 4 = diffuse fibrosis
Sarcoidosis Spirometry
Shows restrictive pattern
FEV1:FVC preserved
Sarcoidosis CT
Shows fissural nodularities
TB shows miliary nodules
Insidious Sarcoidosis Presentation
Difficult breathing
Dry Cough
Weight loss
Malaise
Differentials - TB, Lymphoma
Other Sarcoidosis presentations
Lungs Eyes (Uveitis Iritis) Erythema Nodosum Hepatomegaly VT
Sarcoidosis Steroids Indications
CXR Stage 2 or 3 Disease with symptoms
Hypercalcaemia
Eye, heart, lung involvement
Upper Zone Pulmonary Fibrosis - CHARTS
Coal Worker’s Pneumoconiosis
Hypersensitivity Pneumoconiosis (aka EAA)
Ankylosing Spondylitis
Radiation
TB
Sarcoidosis/Silicosis
Lower Zone Pulmonary Fibrosis
Lower Zone - DIAL
Drugs (Amiodarone)
Idiopathic
Asbestosis
Lupus
Idiopathic Pulmonary Fibrosis - features
SOB
Dry cough
Clubbing
Fine crackles
Hypoxia
Idiopathic Pulmonary Fibrosis - presentation
Common in:
Men
60-70 years old
Median survival is 3 years
Idiopathic Pulmonary Fibrosis - initial treatment on admission
Oxygen alone!!
Drug which slows disease progression of idiopathic pulmonary fibrosis
Pirfenidone
Idiopathic pulmonary fibrosis - CT scan
Honeycombing
