Pulmonary vasculitides, eosinophilia Flashcards
What are cardiac causes of clubbing
Cyanotic HD
IE
Atrial myxoma
What are respiratory causes of clubbing
Lung cancer
TB
Asbestos
Fibrosing alveolitis
CF
Bronchiectasi
Abscess
Empyema
What are other causes of clubbing
Chron’s
Cirrhosis
Grave’s
Whipples
What causes respiratory acidosis
COPD Asthma Pulmonary oedema Neuromuscular Obesity HYpoventilation Benzo / opiate overdose
What causes respiratory alkalosis
Anxiety Hyperventilation PE Salciclyte SAH Encephalitis Stroke Altitude Pregnancy
What is granulomatous polyangiitis
formerly known as Wegener’s granulomatosis.
Necrotizing granulomatous vasculitis affecting upper and lower respiratory tract + kidney
Features
* upper respiratory tract: epistaxis, sinusitis, nasal crusting
* lower respiratory tract: dyspnoea, haemoptysis
* rapidly progressive glomerulonephritis (‘pauci-immune’, 80% of patients)
* saddle-shape nose deformity
* also: vasculitic rash, eye involvement (e.g. proptosis), cranial nerve lesions
Granulomatosis with polyangiitis
How do you investigate
- cANCA positive in > 90%, pANCA positive in 25%
- chest x-ray: cavitating nodules or lesions > CT-PET showing increased uptake > CT guided bx: fibroinoid necrosis
- renal biopsy: epithelial crescents in Bowman’s capsule
Management of Granulomatosis with polyangiitis [4]
- CCS - high-dose methyl- prednisolone
- pulsed IV cyclophosphamide
- Plasma exchange- used for renal disease but its role in pulmonary disease is less clear.
- Remission can be sustained with less aggressive agents, such as azathioprine. Methotrexate can be used as an alternative in less severe renal disease.
What is Churg Straus
Eosinophilic vasculitis
3 stages
Stage 1 =. allergy
Asthma
Sinusitis / rhinitis
Polyps
Stage 2 = eosinophilia
Stage 3 = vasculitis
Heart, lung, GI, kidney
What is Kartamenger syndrome
Primary ciliary dyskinesia
What is suggestive of Katmenger syndrome
Sinusitis
Bronchiectasis
Dextrocardia
Subfertility
What causes altitude sickness
Chronic hyperbaric hypoxia at high altitude
Altitude sickness
How do you prevent and treat
No >500m per day
Acetazolamide
Descent
What can altitude sickness progress too
Pulmonary oedema
Cerebral oedema
Altitude sickness
What does cerebral oedema present with
Headache
Ataxia
Papilloedema
Altitude sickness
How do you treat
Descent
Dexamethasone
Goodpasture’s syndrome
Features, investigation finding
Causes alveolar haemorrhage resulting from anti-glomerular basement membrane (GBM) antibodies that can also cause crescentic glomerulonephritis. Features: pulmonary haemmorrhage
Investigation: renal biopsy shows linear IgG deposits along basement membrane
Pulmonary eosinophilia are a heterogenous group of diseases
Pulmonary eosinophilia causes
associated with eosinophilic alveolar infiltrates and peripheral eosinop
- Parasitaemia, e.g. helminthic infections.
- Resolving pneumonia.
- Hydatid disease.
- Sarcoidosis.
- Polyarteritis nodosa.
- ABPA.
- EGPA.
- Acute and chronic eosinophilic pneumonia.
How would pulmonary eosinophilia typically present?
- Severe haemoptysis is recognized, but is often absent.
- Cough, dyspnoea, pleuritic pain.
- Clinical examination may reveal evidence of underlying extra thoracic and thoracic disease, e.g. purpuric rash, joint pain/inflammation.
- Pulmonary vasculitis should be considered in any persistent, aggressive or unusual presentation of pneumonia.
Contents [4]
Coal Workers Pneumoconiosis (CWP)
Asbestosis
Silicosis
Mesothelioma
CWP
Ep
Ax [2]
Pathophysiology [3]
Ep: countries w/ underground coal mines Ax: inhalation of coal dust particles, over 15-20y Px: - dust particles of 1 to 3 micrometres - ingested by macrophages which die - releasing enzymes and causing fibrosis
CWP
Presentation [2]
Investigations
Asymptomatic
Can co-exist with chronic bronchitis
Ix:
CXR, PFT
