What is the interstitium of the lungs?
Space in between alveoli and bloodstream
Needed to function
What is the role of the lung interstitium?
Release cytokines
Conduit for things to leave circulation and vice versa
Collagen formation
Interstitial diseases can affect many different parts of anatomy/physiology, name a few
Acini Bronchioles Mesenchyme Alveoli lumen Epithelia Macrophages Bronchiolar lumen Inflammatory cells Ventilation Diffusion Perfusion
Interstitial lung disease is what type of defect
Restrictive
What would the FEV1/FVC ratio for ILDs look like
FEV1 reduced
FVC reduced
Therefore ratio about normal
What is a common CXR finding for ILD?
Haziness
Looks like lace over the lungs
What do we call the rounded cystic areas in ILD?
Honeycombing
What are the 2 main symptoms of any ILD?
Chronic shortness of breath
Chronic cough
Give some signs on examination that would chest ILD
Clubbing Cyanosis Tachycardia Tachypnoea Signs of RH failure Decreased chest movement Coarse crackles
What are the classifications of ILDs?
Occupational Treatment related Connective tissue disease Immunological Idiopathic
What is the largest group of ILDs?
Idiopathic
Name some causes of occupational ILD
Asbestos
Silicone
Coal dust (coal workers pneumoconiosis)
Name some treatments that can cause ILD
Radiation Methotrexate Nitrofurantoin (given for UTI) Amiodarone Chemotherapy
Name some connective tissue diseases that can lead to ILD
Rheumatoid arthritis SLE (lupus) Polymyositis Scleroderma Sjogren's
Name some immunological problems that can cause ILD
Sarcoidosis (granulomas)
Hypersensitivity pneumonitis
Describe idiopathic pulmonary fibrosis (IPF)
Commonest ILD 60-80 years Median survival = 3 years Often diagnosed via CT There are new therapies to treat: antifibrotics and vegF inhibitors
Define asbestosis
Interstitial lung disease caused by asbestos
Other than asbestosis, what other problems can asbestos exposure lead to?
Asbestos plaques Diffuse pleural thickening Benign asbestos pleural effusions Mesothelioma Bronchogenic lung cancer Rounded atelectasis
Describe sarcoidosis
Often asymptomatic Sometimes a cough and rash Lung function tests can be normal or abnormal Non-caseating granulomas Differential: lymphoma and TB
What is the treatment for sarcoidosis?
Sometimes no treatment
Steroids
Methotrexate
Which pleura has somatic innervation?
Only the parietal
Describe pleuritic pain
Sharp
Severe
Worse with inspiration
What is the rate of pleural fluid turnover?
15 ml/day
How can liver cirrhosis affect the pleura?
Lack of production of albumin
Decreased oncotic pressure
Increased production of pleural fluid
What changes would cause increased production of pleural fluid?
Increased hydrostatic pressure capillaries
Increased permeability
Decreased oncotic pressure capillaries
What would cause decreased absorption of the pleural fluid?
Lymphatic blockage
Elevated systemic venous pressure
To be called an exudate, pleural protein divided by serum protein must be …
> 0.5
And LDH > 0.6
What might we analyse pleura fluid for?
Appearance Cell count Protein PDH pH Glucose Cytology
What is pleural empyema?
Pockets of fluid
Not evenly affecting the lung
What are the most common cancers to send mets to the lungs?
Breast
Renal
Colon
What are the different types of pneumothorax?
Primary - in otherwise healthy people
Secondary - underlying lung disease
Iatrogenic - eg. Central lines
What are the main symptoms of pneumothorax?
Pleuritic chest pain
Dyspnoea
How is a pneumothorax treated?
Look at CXR
Observation
High flow oxygen
Possibly a chest pain needed
What are the signs of a tension pneumothorax?
CVS compromise - tachycardia, hypotension
Decreased chest expansion
Hyperresonance and absent breath sounds on side of pneumothorax
Shift of mediastinum to opposite side
Hypoxaemia
Name some congenital chest wall abnormalities
Pectus deformities
Scoliosis
Kyphosis
Muscular dystrophy
Name some acquired causes of chest wall disease
Trauma
Iatrogenic
Ankylosing spondylitis
Motor neurone disease
Name some consequences of a chest wall disease
Ventilation failure Poor clearance of secretions Pneumonia Sleep disordered breathing Atelectasis