Flashcards in Dubin Interstital Lung Disease Deck (49)
Acute interstitial Pneumonia v. Idiopathic interstitial Fibrosis
Acute - fast onset (within 7 days)
Idiopathic - progression over a year
50yo with increasing DOE over the past year. Clubbing CXR shows diffuse linear opacities. HRCT shows bilateral abnormalities. Abn PFTs.
Idiopathic interstitial Fibrosis
50yo with acute dyspnea. 7 days of dry cough, SOB, fever, malaise. ABG: pH7.30, PaCO2 65, PaO2 55 on 100% O2. CXR - ground glass, septal thickening.
Acute interstitial Pneumonia
Pathogenesis of Drug Induced Pulmonary Injury - name of injury.
- AMIODARONE results in Acute Interstitial Pneumonitis (also, Organizing Pneumonia, ARDS, Hypersensitivity pneumonia)
- Methotrexate results in interstitial fibrosis
Lipid-laden foamy alveolar macrophages are caused by what @ what dose?
Amiodarone, (over 400mg/day)
Loosely formed, noncaseating epithelioid cell granulomas in interstitium indicative of what?
CXR - (centrilobular) focal patchy consolidation or diffuse ground glass appearance
Acute hypersensitivity pneumonitis
Dx and pathogenesis:
Pet shop owner has EPISODIC (every 4wks for past 6mo) coughing attacks, SOB, recurrent fever.
Hypersensitivity pneumonitis: Bird Fancier's Lung - IgG mediated hypersensitivity due to exposure to feathers and bird droppings.
PFTs in Hypersensitivity pneumonitis
35yo dairy farmer, never smoked, presents with wheezing, mild decrease in FEV1, decreased FVC. CXR normal. Labs reveal eosinophilia and clusters of eosinophils in sputum.
Bronchial asthma - IgE and eosinophilia.
- NOT episodic
22yo sheep and turkey farmer. Episodic periods of wheezing, dyspnea, low grade fever of 100F. Serum precipitans with fungus.
Hypersensitivity Pneumonitis: Farmer's Lung - IgE and IgG, Type 3
- episodic, fever
What do serum precipitans indicate?
Type 3 hypersensitivity reaction.
Thermophilic actinomycetes, think what?
Bilateral infiltrates, think what?
Describe Silo Filler's lung
Respiratory distress due to nitric oxide in grain filled silos
SANDBLASTER, foundry worker, granite worker
CXR: bilateral Eggshell calcifications.
In what regions?
Silicosis - in hilar and mediastinal regions
75yoM with severe dyspnea for a year. No weightloss, chest pain, cough, or hemoptysis. 50 pack year hx. Foundry worker.
Always do what after this diagnosis? Why?
- ALWAYS administer PPD test because TB is increased by 30(?) in silicosis pts
What is a postive PPD test in silicosis pt?
TB is increased by
35yoM with PMG of RA. Treated with gold injections, methotrexate, and aspirin. CXR shows multiple calcified pulmonary nodules in both lungs. Dx?
Caplan's Syndrome = RA + smooth pulmonary nodules.
CXR: Localized pleural fibrous plaques/opacities
ferruginous bodies, mesothelioma
Occupation: autofactory worker, house builder, shipyard worker
47yo roofer and wife of roofer with a 30 pack year hx. Chronic, non-productive cough, DOE. CXR shows thickened, calcified opacities in lateral chest wall and under diaphragm. Clubbing
Asbestosis - can be secondary!
Describe ferruginous bodies
Brown fusiform rods with translucent center with iron-containing material.
CXR: pleural thickening and possible pleural effusion in a shipyard worker who smokes.
Coalescence of particles containing macules that form discrete areas of interstitial fibrosis, causing distention of resp bronchioles, forming areas of emphysema.
Coal Worker's Pneumoconiosis
Prolonged expiratory phase and miner occupation.
Coal Worker's Pneumoconiosis
Nuclear technician moved to Fort Worth. 35yo DOE, dry cough, anorexia, night sweats. Bilateral lymphadenopathy. Sarcoidosis, but no anergy, no elevated ACE, so look for what with what test?
Berylliosis with beryllium lyphocyte proliferation test.