THORACIC Section 9: Interstitial Lung Disease

Question 1

What two main questions should you ask when presented with Interstitial Lung Disease?

Answer 1

1. Acute or chronic?
2. What is the primary finding?

Question 2

What is this density that obscures underlying vessels?

Answer 2

Consolidation

Question 3

What is this density that does NOT obscure underlying vessels?

Answer 3

Ground Glass opacity

Question 4

It is the smallest part of the lung that is surrounded by connective tissue.

Answer 4

Secondary Pulmonary lobule

Question 5

What runs in the middle of the secondary pulmonary nodule?

Answer 5

Terminal bronchiol and and artery

Airway and Artery

Question 6

What runs at the periphery of the secondary pulmonary nodule?

Answer 6

Veins and Lymphatics

Question 7

Described the pleural nodule pattern.

Answer 7

Random

Question 8

Described the pleural nodule pattern.

Answer 8

Perilymphatic

Question 9

Described the pleural nodule pattern.

Answer 9

Centrilobular

Question 10

Pleural nodules that Abut the pleura

Answer 10

Perilymphatic or Random

Question 11

Pleural nodules that does not abut the pleura

Answer 11

Centrilobular

Question 12

Nodule vocabulary
Subpleura + peribronchovascular

Answer 12

Perilymphatic

Question 13

Nodule vocabulary:
Not subpleural or peribronchovascular predominant

Answer 13

Random

Question 14

Key Differentials

Perilymphatic nodule pattern

Answer 14

Sarcoid (90%)
Lympahgitic Spread of CA
Silicosis

Question 15

Key Differentials

Random nodule pattern

Answer 15

Miliary TB
Metastasis
Fungal

Question 16

Key Differentials

Centrilobular nodule pattern

Answer 16

Infection
RB-ILD (Respiratory Bronchilitis ILD)
Hypersensitivity Pneumonitis

Question 17

This reticulonodular abnormality outlines the lobules’ characteristic shape and size (About 2 cm).

Answer 17

Interlobular Septal Thickening

Question 18

Symmetric and smooth interlobular septal thickening is usually seen in what condition?

Answer 18

Pulmonary edema

Question 19

Aymmetric and nodule interlobular septal thickening is usually seen in what condition?

Answer 19

Lymphangitic spread of neoplasm

Question 20

Cystic areas of lung destruction in a subpleural location

Answer 20

Honeycombing

Question 21

Hallmark of UIP

Answer 21

Honeycombing

Question 22

What condition mimics honeycombing?

Answer 22

Paraseptal emphysema

Question 23

One row of bubbles of subpleural cystic areas

Answer 23

Paraseptal Emphysema

Question 23

2-3 rows of bubbles of subpleural cystic areas

Answer 23

Honeycombing

Question 23

Causes of Interstitial Pneumonias

Answer 23

Idiopathic Collagen vascular disease medications inhilation

Question 24

The MOST COMMON Interstitial Lung Disease (ILD)

Answer 24

Unutual Interstitial Pneumonia (UIP)

Question 25

First finding of UIP in X ray

Answer 25

Reticular pattern in the posterior costophrenic angle

Question 26

What is the definite UIP Criteria?

Answer 26

1. Honeycombing (must be present) +/- traction bronchiectasis 2. Reticular abnormalities 3. Subplerual basal predominant distribution 4. Absence of inconsistent features: Upper lobe GG>reticulations Air trapping involving 3 or more lobes

Question 27

Definite UIP pattern = Biopsy?

Answer 27

Doesn't need a biopsy to prove diagnosis.

Question 28

UIP Buzzwords!

Answer 28

Apical to basal gradient Traction bronchiectasis Honeycombing Heterogeneous on Histology

Question 29

Chronic hypersensitivity Pneumonitis (HP) vs IUP Features favoring chronic HP?

Answer 29

Air Trapping involving 3 more lobes Mid-upper lobe predominant fibrosis

Question 30

Pulmonariy fibrosis is a risk factor for?

Answer 30

Lung CA

Question 31

Cancer in fibrotic Lung favors what lobe?

Answer 31

Lower lobes

Question 32

Cancer in fibrotic Lung favors what interface?

Answer 32

Fibrotic cysts and normal lung

Question 33

ILD that is a common pattern in collagen vascular disease, and drug reactions

Answer 33

Nonspecific Interstitial Pneumonia (NSIP)

Question 34

ILD: Homogeneous inflammation or fibrosis

Answer 34

NSIP UIP - heterogeneous

Question 35

Two FLAVORS of NSIP

Answer 35

Cellular or fibrotic

Question 36

NSIP Groundglass alone

Answer 36

Cellular

Question 37

NSIP GG+Reticulation

Answer 37

Cellular or fibrotic

Question 38

NSIP Reticulation + Traction Bronchiectasis

Answer 38

Fibrotic NSIP

Question 39

NSIP Honeycombing

Answer 39

Uncommon and minimal

Question 40

The most common ILD in scleroderma

Answer 40

NSIP

Question 41

ILD Immediate subpleural sparing

Answer 41

NSIP

Question 42

NSIP vs UIP Presence of micronodules

Answer 42

NSIP

Question 43

Apical Centrilobular ground glass nodules

Answer 43

Respiratory Bronchiolitis ILD (RB-ILD)

Question 44

More diffuse GGO, with patchy or subpleural distribution

Answer 44

Desquamative interstitial pneumonia (DIP)

Question 45

ILD showing Localized centrilobular ground glass nodules (due to macrophages filling up the terminal bronchioles).

Answer 45

RB-ILD

Question 46

Thought as an end spectrum of RB-ILD

Answer 46

DIP

Question 47

Filling of alveolar spaces with macrophages

Answer 47

DIP

Question 48

Peripheral lower lobe predominant GG with small cystic spaces

Answer 48

DIP

Question 49

This is a multi-system disease that creates “non-caseating granulomas.”

Answer 49

Sarcoid

Question 50

Classic triad of Bilateral hilar lymph node enlargement Arthtitis Erythema nodosum

Answer 50

Acute Sarcoid

Question 51

bilateral hila and right paratracheal

Answer 51

1-2-3 sign in sarcoid

Question 52

Diagnosis?

Answer 52

NSIP

Question 53

Diagnosis?

Answer 53

UIP