Lung Fibrosis

Question 1

It is important to be able to differentiate between conditions causing predominately upper or lower zone fibrosis. It should be noted that the more common causes (idiopathic pulmonary fibrosis, drugs) tend to affect the?

Answer 1

lower zones

Question 2

Fibrosis predominantly affecting the upper zones?

Answer 2

• hypersensitivity pneumonitis(also known as extrinsic allergic alveolitis)
• coal worker’s pneumoconiosis/progressive massive fibrosis
• silicosis
• sarcoidosis
• ankylosing spondylitis(rare)
• histiocytosis
• tuberculosis
• radiation-induced pulmonary fibrosis
  • may develop following radiotherapy for breast or lung cancer
  • typically seen between 6 and 12 months following completion of radiotherapy course

Question 3

Fibrosis predominately affecting the lower zones?

Answer 3

• idiopathic pulmonary fibrosis
• most connective tissue disorders (except ankylosing spondylitis) e.g.SLE
• drug-induced:amiodarone,bleomycin,methotrexate
• asbestosis

Question 4

Acronym for causes of upper zone fibrosis:

Answer 4

CHARTS

C - coal worker’s pneumoconiosis

H - Histiocytosis / hypersensitivity pneumonitis

A - Ankylosing spondylitis

R - Radiation (ratiotherapy)

T - TB

S - Silicosis/sarcoidosis