|
Interstitial Lung Disease
|
|
|
Causes
|
• Vasculitis (eg, granulomatosis with polyangiitis)
• Infections (eg, fungal, tuberculosis, viral pneumonia)
• Occupational & environmental agents (eg, silicosis, Common hypersensitivity pneumonitis)
• Connective tissue disease (eg, systemic lupus erythematous, scleroderma)
• Idiopathic pulmonary fibrosis, interstitial pneumonia
• Cryptogenic organizing pneumonia
|
|
S/S
|
• Progressive exertional dyspnea or persistent dry cough
• Pulmonary findings due to other underlying conditions (eg, silicosis, connective tissue disease)
• 50% of patients with significant smoking history
• Lung examination with fine crackles during mid-late inspiration, possible digital clubbing
|
|
Dx
|
• CXR: reticular or nodular opacities
• High-resolution chest CT: fibrosis, honeycombing, or traction bronchiectasis
• PFTs: ⓝor ⤴️ FEV1/FVC ratio, ⤵️ DLCO,
• Resting arterial blood gas can be normal or show mild hypoxemia
• Exertion usually causes significant hypoxemia due to V/Q mismatch
|
|
Sarcoidosis
|
|
|
#
|
African Americans
|
|
S/S
|
Pulmonary: ⓑ hilar LN I Interstitial infiltrates
Skin
· Papular, nodular, or plaque-like lesions
· Erythema nodosum
Ophtha:
· Anterior/posterior uveitis
· Keratoconjunctivitis sicca
Hema: Peripheral LN ⊕ I HSM
MSK: Acute polyarthritis (especially ankles)
CVS:
· AV block
· Dilated or restrictive cardiomyopathy
CNS:
· 7th CN Palsy
· Central DI
|
|
Imaginc
|
ⓑ Hilar LN
|
|
Labs
|
· ⤴️ Ca / ⤴️ Ca in urin
· ⤴️ ACE level
|
|
Bx
|
Noncaseating granuloma
|
|
Tx
|
Steroids
|
|
Obesity Hypoventilation Syndrome
|
|
|
Dx criteria
|
· BMI ≥30
· Awake daytime hypercapnia (PaCO2 >45)
· No altemate cause of hypoventilation
|
|
Work-up
|
· ABG on room air (hypercapnia, normal A-a gradient)
· No intrinsic pulmonary disease on chest x-ray
· Restrictive pattern on PFTs
· Normal TSH
· Polysomnography
|
|
Tx
|
· Noctumal positive-pressure ventilation as first-line therapy
· Weight loss (bariatric surgery in select cases)
· Avoidance of sedative medications
· Respiratory stimulants (Acetazolamide) as last resort
|
|
Asbestosis
|
|
|
RF
|
· Prolonged Asbestos exposure (Shipyard, mining)
· Sx develop ≥20 years after initial exposure
|
|
S/S
|
· DRY COUGH
· Progressive SOB,
· Basilar fine crackles,
· Clubbing
· ⤴️ Risk for Lung cancer & Mesothelioma
|
|
Dx
|
· Pleural plaques on chest imaging
· Imaging, PFT & histology consistent w/ pulmonary fibrosis
|
Fast HY Review 