Diffuse and Interstitial Lung Disease Flashcards Preview

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Flashcards in Diffuse and Interstitial Lung Disease Deck (34):
1

Diffuse vs interstitial

Diffuse - involving parenchyma of both lungs

interstitial - diffuse lung dz that preferntially involves lung interstitium

Lung is either sole organ or might be part of multisystem

2

Ground glass opacification

Airspace filling less dense than consolidation

Alveolitis
Edema
Alveolar hemorrhage
Alveolar proteinosis

3

When to think of

Pneumocysttis
Alveolar hemorrhage

Fever, HIV risk

Hemoptysis

4

Ground glass
Reticular pathology

Alveolitis (after infectious pnuemonia, edema, hemorrhage and alveolar proteinosis excluded)

Collagen deposition/intersitital inflammation/interstitial edema/lymphatic process

5

Small nodules
Honeycomb
Traction bronchiec

Granuloamtous inflammation/infection/inhaled dust/neoplastic spread

End-stage lung fibrosis

6

Sarcoidosis
DIP
Alveolar proteinosis

Patho findings

Non-necortizing, well-formed granulomas...expect nodules

Desquam interstitial pneumonitis...ground glass opacities by imaging

PAS material filling alveolar without cells

7

IPF

Age, mutation, radio, patho

50s

Telomerase gene mutation (familal version)

Basilar, sub-pleural predominant reticular infiltrates

No associated PE or thoracic LN enlargement

Low titer ANA and RF may be present

Heterogeneity in extent and appartent age of lesions with little inflammation

8

IPF dx

Typical presentation and HRCT OR surgivcal biopsy

9

Asbestosis dx

Similar to IPF but with a plaque

10

Rheumatoid contrasted with IPF, HP, silicosis

Will have extra-pulm findings

Chronic HP will be upper lobe involvement

Silicosis is nodular and upper-lung

11

Pneumoconiosis

Respirable particles must be small enough to reach alveoli but large enough to not be breathed out

Most spherical except asbesots fibers

Look for ferruginous bodies in asbestos

12

Patho of silocosis vs. sarcoidosis, vs coal miners

All going to be upper lobe predominant

Carbon laden macrophages - CWP

Silicotic nodules - silliociss

Sarcoidosis - well-formed granuloma with multinucleated giant cells

13

Silicosis and CWP similarities and differences

Upper and mid zone predom nodular infiltrates

Simple and PMF varieites

Thoracic adenopathy may calcify

Diffs***

Silicotic nodule vs. macule

Silica polarizble

Silica has acute varient that mimics alveolar proteinosis

14

Asbestosis

Lower zone reticular infiltrates (mimics IPF)

NO adenopathy

PLeural plaques

Ferruginous bodies

15

Pneumonoconiosis dx by

Appropritate hx and imaging (maybe with path)

16

Sarcoidosis including dx

MULTIsystem disorder by non-caseating granulomatous infalmmation

Mimicked by berylliosis

dx - demonstration of non-caseating granulomas in 2 or more organs...exclude other dx

Will be nodular

May get hilar adenopathy

17

COP Path
Hx
Dx

Exuberant lung repair occurring in response to insult

Very important clinical hx - cough, dyspnea, fever of weeks-months

Recognitionf of syndrome as less acute than bacterial, evaluating potnetial predisposing condiions, characteristic lung patho, negative cultures

18

Alveolar hemorrhage syndromes

Hemoptysis with dyspnea

Urinalysis shows RBCs

Bilateral symmteric aispace filling (GGO)

Patho shows diffuse capillaritis

GPA - diagnositc is ANCA (proteinase 3)

Anti-glomerular basement membrane antibody disease - GBM antibody (cross reacts with alveolar basement membrane)...has linear glomerular distribtuion of IgG

Both are pulm-renal syndromes

19

Alveolar proteinosis

Chronic, non-infectious airspace opacities

Antibody to GM-CSF leads to excess surfactant production

SLowly progressive dyspnea and cough

IMaging is bilateral airspace opac with crazy paving

Dx by lavage or biopsy (PAS)

Therapy is whole-lung lavage plus GM-CSF

20

Goodpastures vs. GPA

Goodpastures has no ENT findings (or findings outside of the pulm-renal system)

21

HP is

Parenchymal lung dz resulting from inhlaation of an antigen to which pt has been previously sensitized

22

Patho of HP

Inhlaed antigen stimulates TLR (Th1 and Th17)

23

Smoking and ILD

SMokers get - respiratory bronchioltis - ILD
Desquamative interstitial pneumonia
Langerhands

Non-smokers get - HP and sarcoidosis...difference is that sarcoisosi does NOT have crackles

24

Acute
SUbactue
Chronic HP

Acute- non-specific bilateral airspace dxz with ground glass

Subactue- ground glass, centrilobular nodules, mosaic

Chronic - looks like IPF

25

Radiation pneumonitis and fibrosis

Fibrosis more than pneumonitis

Crackles, dry cough, dyspnea

Dx made by hx and imagingin...patho is diffuse alvolar damage and organziing pneumonia

26

IPF important

Peripheral, basilar, reticular with honeycombing

Finger clubbing

Heterogenous fibrosis admixed with more normal lung

27

DIP important

Begins as GGO with little interstitial thickening

SMokers dz

Uncommonly progresses to end-stage fibrosis

28

Sarocidosis

Multisystem and granulomatous with thoracic adenopathy and nodular

Endemic fungi

Beryllioss is exact mimic

29

Pneumoconisosi

Silicosis and CWP are upper, nodular and have thoracic adenopathy

Asbestor - lower lobe, reticular, no adenopathy and honeycombing

30

COP

Airspace that radiographically looks more like pneumonia but clinically indolent

Inflam change with myxomatous granulation

Steroid responsive

31

Alv hemorrhage

Airspace dx caused by cpaillaritis - ANCA vasculitis and anti-GBM dz

32

ALveolar proteinosis

Airspace

AB to GM-CSF and macros can;t remove surfactant

PAS+ material in alveolar space

Unusla infections occur

33

HS penumonotis

3 types

Chronic - IPF mimic
Subacute - sarcoidosis mimic
Antibides not part of patho

34

Radiation

2 forms

Over 40 Gray dose

Pneumonits about 8 weeks after XRT conclusion

Dx by history and sharp bordered