Pulmonary Manifestation of Systemic Disease Flashcards Preview

CVPR: Pulmonary > Pulmonary Manifestation of Systemic Disease > Flashcards

Flashcards in Pulmonary Manifestation of Systemic Disease Deck (16)
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1

Differential Dx mneumonic

  • VINDICATE
  • Vascular
  • Infection
  • Neoplasm
  • Drugs
  • Inflammatory/idiopathic/iatrogenic
  • Congenital
  • Autoimmune
  • Trauma
  • Endocrine/metabolic

2

Pulmonary anatomic differential includes:

•Airways •Alveoli •Interstitium •Vascular •Pleura •Chest wall •Extrathoracic

3

ALS + pulmonary manifestations

  • progessibve neurogenerative disease --> weakness
  • •Chronic aspiration due to uncoordinated pharyngeal muscle movement (“bulbar dysfunction”)
  • •Recurrent pneumonia
  • •Respiratory muscle weakness
    • –Inadequate ventilation
    • –Nocturnal hypoventilation
    • –Weak cough

4

Dx of pulmonary disease associated w/ALS

  • CXR: right middle lobe infiltrates from chronic aspiration + low lung volumes
  • PFTs:
    • Restrictive pattern: airflow symmetrically reduced; reduced TLC
    • •Reduced maximal inspiratory pressure (MIP) and reduced maximal expiratory pressure (MEP)
    • •Reduced maximum voluntary ventilation (MVV) 
    • •Generally normal DLCO initially; prolonged hypoventilation results in atelectasis and shunt.

5

Neuromuscular diseases (acute, relapsing, chronic)

•Acute: Guillain-Barre (GBS)

•Relapsing: Multiple sclerosis (MS), myasthenia gravis (MG)

•Chronic, progressive: ALS

 

6

Neuromuscular diseases anatomical locations

•Spinal cord: MS, infarct, trauma, tetanus, transverse myelitis, tumors

•Motor nerves –ALS, polio, GBS, Phrenic nerve injury

•NM junction –Botulism, MG, Lambert Eaton, organophosphates

•Muscles –HypoK, hypophos, muscular dystrophy, polymyositis, thyroid disease

7

RA + pulmonary manifestation

  • RA = systemic autoimmune disease w/symmetric inflammatory arthritis
  • •Pleuritis
  • •Pleural Effusion
  • •Airway obstructions
  • •Interstitial Lung Disease (UIP > NSIP)
  • •Pulmonary Hypertension
  • •Drug reactions (esp methotrexate, sulfasalazine)
  • •Pulmonary infections due to immunosuppression

8

Connective tissue disease w/pulmonary manifestation

  • SLE
  • RA
  • •Systemic sclerosis (scleroderma)
  • •Sjogren’s disease (autoimmune destruction of exocrine glands)
  • •Dermatomyositis/polymyositis
  • •Mixed connective tissue disease
  • •Ankylosing spondylitis

9

Systemic diseases that lead to diffuse alveolar hemorrhange + renal disease

•Granulomatosis with polyangiitis (formerly Wegener’s)

•Microscopic polyangiitis

•Churg-Strauss Syndrome

•Goodpasture’s Syndrome (Anti-GBM disease)

•Systemic Lupus Erythematosus

•Systemic Sclerosis (Scleroderma)

•Henoch-Schonlein Purpura

•Cryoglobulinemia

10

Pulmonary manifestations of IBD

  • •Tracheobronchitis
  • •Bronchiectasis  ==> obstructive
  • •Bronchiolitis ==> obstrutive
  • •Pleural Effusion ==> restrictive
  • •Interstitial Lung Disease ==> restrictive
  • •Pulmonary embolism
  • •Drug complications
  • •Infections

11

Common types of Obstructive disease

–Tracheobronchitis

–Bronchiectasis

–Bronchiolitis

12

Common Types of Restrictive Disease

–Pleural Effusion

–Interstitial Lung Disease

13

Pulmonary Manifestation of Sickle Cell Disease

  • •Infection 
  • •Embolic phenomena due to bone marrow infarction and fat emboli
  • •Infarction caused by in-situ thrombosis
  • •Hypoventilation due to rib and sternal infarctions
  • •Pulmonary Edema due to excessive hydration
  • •Pulmonary hypertension
  • •Chronic lung disease

14

Pulmonary complications in HIV (infectious)

•Bacterial pneumonia

•Tuberculosis

•Pneumocystis jirovecii (PCP)

•Fungal pneumonia

•Viral pneumonia

15

Pulmonary complications in HIV (noninfectious)

•Kaposi’s sarcoma

•Non-Hodgkin’s lymphoma

•Lung cancer

•Emphysema

•ILD

 •Pulmonary HTN

•Effusions –Parapneumonic –TB –Malignant; esp lymphoma

16