Trigger - Interstitial lung disease Flashcards
assocaited with accumulation of T lymphocytes, macrophages, and epitheloid cells
granulomatous lung disease (ILD)
Fatigue, weight loss, worsening dyspnea, non productive cough
symtpoms assocaited with ILD
cachexia, tachypnea, late inspiratory rales, rhonchi
ILD
holosystolic tricuspid regurgitation murmur
late ILD with pulmonary HTN
may also hear:
loud P2 component of 2nd heart sound
fixed spli S2
what is cor pulmonale
the term used to describe RV enlargement, dysfunction and subsequent failure
associated with excessive production and dysregulation of myofibroblasts
idiopathic pulmonary fibrosis
MC onset 55 y/o, more male predominant
idiopathic pulmonary fibrosis
Which ILDs present with obstructive PFT pattern
- hypersensitivity
- sarcoidosis
- complicated diseases (ex. in presence of COPD)
HRCT shows traction bronchiectasis
idiopathic pulmonary fibrosis or sarcoidosis
biopsy shows alternating areas of healthy lung, interstitial inflammation, fibrosis, and honeycomb change
idiopathic pulmonary fibrosis
nintedanib or pirfenidone are used in treatment for what
idiopathic pulmonary fibrosis
what dx is associated with encouragement of patients to apply for clinical trials
idiopathic pulmonary fibrosis
tyrosine kinase inhibitor used in IPF
nintedanib
anti-inflammatory/antifibrotic agent
pirfenidone
CI in liver disease
antifibrotics
may be exacerbated by the COVID mRNA vaccine
IPF
characterized by the presence of noncaseating granulomas in 2+ organ systems
sarcoidosis
MC in african american women and northern europeans
sarcoidosis
may see insidious onset of fever, fatigue, night sweats and weight loss
sarcoidosis
also dyspnea and cough for 2-4 weeks
presents with conjunctival lesions and scleral plaques
sarcoidosis!
also presents with anterior/posterior granulomatous
may lead to blindness if left untreated
sarcoidosis
insidious onset of blurred vision, slight photophobia and pain
anterior granulomatous uveitis
maculopaper lesions
sarcoidosis
also seen:
erythema nodosum
lupus pernio
erythema nodosum
sarcoidosis
also see:
lupus pernio
maculopaper lesions
lupus pernio
sarcoidosis
also see;
maculopaper lesions
erythema nodosum
painless loss of visual field with scotomas and floaters
posterior granulomatous uveitis
can present with hypercalcemia or hypercalciuria
sarcoidosis
presents with elevated ESR
sarcoidosis
can present with elevated ACE
sarcoidosis
assocaited with suppressed PTH
sarcoidosis
Granulomas produce 1,25 dihydroxyvitamin D which increases intestinal absorption of Ca - ultimately results in a suppressed PTH
what are the things that pulmonary granulomas are known to secrete
1,25 dihydroxyvitamin D
ACE
CXR with hilar adenopathy and/or infiltrates
sarcoidosis
biopsy showing noncaseating granulomas
sarcoidosis
increased lymphocytes in bronchoalveolar lavage
sarcoidosis
high CD4/CD8 ratio
sarcoidosis
what pulmonary disease has cardiac involvement found in 5% of patients
sarcoidosis
associated with CXR that shows macules usually 2-5 mm in diameter as well as small <1cm rounded opacities
coal workers pneumoconiosis (uncomplicated)
these macules are called coal macules!
asymptomatic, minimal changes on PFT, small (<1 cm) rounded opacities on CXR
coal workers pneumoconiosis (uncomplicated)
CXR showing nodules ≥1 cm in diameter generally confined to the upper half of the lungs
complicated coal workers pneumoconiosis
endobronchial involvement in sarcoidosis would precipitate which PE finding?
wheezing!
cough, SOB, pleuritic pain, weight loss, fatigue
acute silicosis (likely complicated)
CXR shows small (<10mm) nodules scattered diffusely throughout lungs. more prominent in upper lobes
simple silicosis
CXR shows bilateral upper lobe masses formed by coalescence of nodules
complicated silicosis
increased risk of TB d/t alveolar macrophage dysfunction
silicosis
CXR shows linear opacities, multinodular parenchymal opacities and pleural plaques
asbestosis
visceral and parietal plerua are damaged while central portions of the lung are spared in this disease
asbestosis
bronchoalveolar lavage showing small rods through macrophages even in patients who are asymptomatic
asbestosis! these rods are called “asbestos bodies”
this disease in conjunction with smoking, increases risk of mesothelioma
asbestosis
inflammatory pulmonary disease resulting from exposure to inhaled organic antigens leading to an acute illness
hypersensitivity pneumonitis
presents as flu like illness (chills, fever, malaise, cough, chest tightness, dyspnea)
acute hypersensitivity pneumonitis
onset within hours following exposure of irritant, gradual improvement 12 hours - several days after.
acute hypersensitivity pneumonitis
CXR shows a poorly defined micronodular or diffuse interstitial pattern
acute hypersensitivity pneumonitis
onset of productive cough, dyspnea, fatigue, anorexia, and weight loss over weeks to months
subacute/chronic hypersensitivity pneumonitis
CXR showing progressive fibrotic changes with loss of lung volume and coarse linear opacities
subacute/chronic hypersensitivity
what is treated with steroids
- hypersensitivity pneumonitis
- sarcoidosis
all others are not indicated anymore!
insidious onset of dyspnea, intractable dry cough, chest fullness or pain, weakness, and fever
radiation lung disease
what three diseases can present with fever?
radiation lung disease
sarcoidosis
acute hypersensitivity
In what disorders are air bronchograms observed in CXR
radiation lung injury
CXR shows obliteration of normal lung markings with dense interstitial and pleural fibrosis.
pulmonary radiation fibrosis
may also see:
reduced lung volumes
tenting of the diaphragm
sharp delineation of irradiated area
CXR showing reduced lung volumes, tenting of the diaphragm and sharp delineation of one area of the lung
pulmonary radiation fibrosis
may also see:
obliteration of normal lung markings with dense interstitial and pleural fibrosis.
