Pulm-Diffuse Parenchymal Lung Disease

Question 1

Diffuse Parenchymal Lung Disease (DPLD) formerly Interstitial Lung Disease (ILD)

Answer 1

Path: Variable (see above)

Pt: Chronic, insidious onset
Dry cough 
Hypoxemia
Restrictive picture 
Dry crackles 

Dx: CXR
High resolution CT
Bx = VATS

Tx: Anti-inflammatories

• DMARDs
• Biologics
• Steroids

F/u: O2 supplementation if SpO2 < 88%

Question 2

Sarcoid

Answer 2

Path: autoimmune, infiltrating disease

Pt: Young, African American Woman
Bilateral hilar lymphadenopathy
Erythema nodosum

Dx: 1st CXR = Bilateral hilar lymphadenopathy
Then: PFTs = restrictive disease
Best: biopsy = noncaseating granuloma

Tx: prednisone

F/u: nothing?

Other: Hypercalcemia….VIT D from granuloma
Bradycardia / Block = infiltrating heart
Restrictive Cardiomyopathy

Question 3

Asbestosis

Answer 3

Path: Inhaled, non-degradable material

Pt: Construction worker
shipyard industry
Lung cancer or interstitial lung disease

Dx: 1st CXR = Pleural Plaques
Best: Biopsy = Barbell bodies

Tx: Smoking cessation

F/u: High risk for adenocarcinoma of lung

Question 4

Occupational Exposures

Answer 4

Pneumoconiosis - heavy metal, ground-glass opacities

Asbestosis - shipyards, construction, demolition;
pleural plaque

Silicosis - Rock dust, sand blasting

Coal Miner’s - Coal, Caplan Syndrome

Hypersensitivity Pneumonitis - noncaseating granulomas, pigeon feathers, actinomyces

Question 5

Special Considerations

Answer 5

shipyards = asbestosis = cancer

Construction = asbestosis = cancer

Aeronautics = berylliosis

Nuclear = berylliosis

Sand blasting = silicosis = TB

Rock Quarries = Silicosis = TB

Birds = HE = Get away from birds

Work only = HE = Get away from work