Pulmonary Fibrosis

Question 0

Causes of upper lobe pulmonary fibrosis

Answer 0

Extrinsic allergic alveolitis (hypersensitivity pneumonitis)
Ankylosing spondylitis
Sarcoidosis
Allergic bronchopulmonary aspergillosis (ABA)

Question 1

Pulmonary fibrosis

Answer 1

The development of fibrotic scarring of the lung tissue
This produces a restrictive SOB, dyspnoea and cough
Decreased TCO, FEV, FVC & TLC

Question 2

Causes of lower lobe pulmonary fibrosis

Answer 2

Idiopathic Pulmonary fibrosis
Asbestosis
Rheumatoid arthritis
Drugs

Question 3

Drug causes of lower lobe pulmonary fibrosis

Answer 3

Amiodarone
Methotrexate
Bleomycin
Nitrofurantoin
Others (less common)

Question 4

CXR appearance of pulmonary fibrosis

Answer 4

Increased bilateral interstitial markings and distortion of the underlying parenchymal architecture
May appear as ‘ground-glass’ shadowing at the lung borders

Question 5

Extrinsic allergic alveolitis (hypersensitivity pneumonitis)

Answer 5

Often caused by organic dusts due to work (farmers, detergents, paints, Moldova hay) or hobbies (pigeon fanciers lung)

Question 6

Features of interstitial lung disease

Answer 6

Fibrosis and remodelling of interstitium

Hyperplasia of type II epithelial cells

Question 7

Causes of interstitial lung disease

Answer 7

Known cause (environment, nitrofurantoin/bleomycin/amiodarone/sulfasalazine/busulfan, hypersensitivity, infection, GORD)
Associated with AI
Idiopathic

Question 8

CXR in silicosis

Answer 8

Diffuse miliary/nodular pattern in upper zone with egg shell calcification of hilar nodes

Question 9

Asbestos fibres in order of fibrogenicity

Answer 9

Chrysotile (white) < amosite (brown) < crocidolite (blue)