Glossary of Diffuse Infiltrative Lung Disease
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- Define diffuse infiltrative lund disease
- Non-infectious, non-malignant processes of lower respiratory tract
--> restrictive ventilatory impairment, diffuse interstitial infiltrates
Progressive and fatal
- What % of DPLD pts are asymptomatic?
- Most common presentation of DPLD
Cough Abnormal CXR
- What functional abnormalities are seen in DPLD?
- Reduced TLC, VC, FEV1, RV
FEV1/FVC = normal
Abnormal gas exchange
- What is the best way to dx DPLD using radiograph?
- HR CAT scan is most sensitive way
- What physical findings are most common in DPLD?
- Crackles (common in IPF, rare in granulomatous dz)
Signs of cor pulmonale
- What are general features of sarcoidosis?
More common in?
- Unknown etiology
10x more common in blacks
Most common in 20-30 yo
Organ dysfxn from presence of granulomas in tissue
- What is the common presentation of sarcoidosis?
- 12-35% asymptomatic
Any pulmonary sx
- What are the most common findings of extrapulmonary sarcoidosis
- CNS involvement
- What is seen on CXR in sarcoidosis?
- Bilateral hilar adenopathy (most common)
Diffuse reticular, reticulonodular, nodular
Multiple large nodules
Diffuse alveolar infiltrates
Can be **normal**
- What is the dx for sarcoidosis based on?
- Dx of exclusion
- What is the prognosis for sarcoidosis?
- 1/3 resolve spontaneously
1/3 stay the same
some have permanent loss of lung fxn (including severe fibrosis)
- Other than sarcoidosis, what are the other granulomatous diseases?
- Hypersensitivity pneumonitis
Chronic beryllium disease
- What are some sources that can cause hypersensitivity pneumonitis?
- mammalian and avian protiesn
Thermophilic bacteria and fungi
- What are the different syndromes of acute hypersensitivity pneumonitis?
- Acute form
- What are the sx of acute hypersensitivity pneumonitis?
- After intermittenet and intense exposure wth sx 4-8 hrs exposure
- What are teh sx of subacute and chronic hypersensitivity pneumonitis
- Continual low level exposures
Insidious onset of dyspnea and fatigue
Chronic can have irreversible lung damage
- What does the acute hypersensitivity pneumonitis look like on CXR?
- Diffuse Ground glass appearance or air-space consolidations
- What does the subacute hypersensitivity pneumonitis look like on CXR?
- Fine nodular or reticulonodular pattern
- What does the chronic hypersensitivity pneumonitis look like on CXR?
- Mostly reticular pattern
- Where is the lung damage in hypersensitivity pneumonitis?
- Upper 2/3 of lung
- What can be used to treat pneumonitis?
- Early dx and Ag avoidance are key
Corticosteroids for tx of acute disease
- What are the different forms of silicosis?
- Simple and Complicated
- What is simple silicosis?
- Asymptomatic or chronic cough from exposure of silicon dioxide
- Where is the abnormality in silicosis? What is seen on CXR in simple silicosis?
- Upper zone
Small rounded opaacities <10mm diameter
- What disease increases TB risk significantly?
- What is complicated silicosis?
- Progressive massive fibrosis
Occurs when smaller opacities coalesce
- What sx are seen in complicated silocosis?
- Minimal to severe dyspnea
- What is seen on CXR in complicated silicosis?
- Confluent nodules >10mm
- What is the morphology of chronic beryllium disease? LOCATION!
- Non-caseating granulomas in lung parenchyma and hilar nodes
- What are examples of interstitial inflammation/fibrosis?
- Bleomycin toxicity
Chronic radiation fibrosis/bronchiectasis
Idiopathic interstitial pneumonia
- What things are risk factors for bleomycin toxicity?
- Renal insufficiency
Radiation to chest
- When are changes from chronic radiation seen?
- 4-6 monhts after therapy
- When does fibrosis from radiation become stable?
- 9-12 months after
- What is seen on physical exam in asbestosis?
- Basal crackles
Clubbin (late stages)
Lower lobe linear opacities
Early fibrotic changes with HR CAT scan
- What are complications of asbestos exposure?
- Pleural effusion (clear spont)
Lung CA increased risk
- What is idiopathic interstitial pneumonia?
- Group of disease w/o identifiable cause --> diffuse parenchymal lund dz
- How is IIP classified?
- Histological patterns
- What is mean age of onset of IIP?
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