What are the imaging findings seen in interstitial diseases?
What is the mnemonic used to recall these diseases (just the abbreviation, not each disease)?
"Scratchy" appearing infiltrates.
Recall the interstitial infiltrates referred to in the mnemonic "SHITFACED".
S - Sarcoidosis
H - Hypersensitivity pneumonitis
I - Interstitial lung dz
T - Tumor or TB
F - Fungal
A - Asbestosis
C - Collagen vascular dz
E - Eosinophilic granuloma
D - Drugs
How does sarcoidosis appear on histology of lung biopsy?
Granulomas (epithelioid histiocytes, giant cells) in a "lymphatic" distribution. Relatively normal alveoli.
Recall the four stages of Sarcoidosis as determined by imaging findings.
Stage I - Hilar lymphadenopathy
Stage II - Hilar lymphadenopathy & Lung infiltrate
Stage III - Lung infiltrate
Stage IV - Fibrosis
What other organs are involved in sarcoidosis?
Eyes (Uveitis), skin (lupus pernio & erythema nodosum), CNS, heart, liver, joints, kidney...
How does ARDS appear on CXR?
Recall the mnemonic used to recall alveolar infiltrates.
(and what it stands for)
P - Pus
C - Cells (RBC, eosinophil, tumor)
P - Protein
I - Inflammatory elements
E - Edema
Recall the criteria needed for an ARDS diagnosis.
Acute onset (<7days), fluid overload, bilateral infiltrates.
With respect to assisted ventilation:
Is a higher or lower tidal volume better?
Is a higher or lower PEEP better?
Is liberal or conservative fluid resuscitation better?
For maximum survival and shortest time on the ventilator:
Low tidal volume
(PEEP not significant)
Conservative fluid resuscitation
What other techniques are helpful in managing ventilated ARDS patients?
What techniques do not make a difference?
Pronation, paralysis (maybe).
Short-term diet control and statins do not help. Beta-agonists (older) and surfactant (neonates) on a specific basis.