Differential Dx mneumonic
- VINDICATE
- Vascular
- Infection
- Neoplasm
- Drugs
- Inflammatory/idiopathic/iatrogenic
- Congenital
- Autoimmune
- Trauma
- Endocrine/metabolic
Pulmonary anatomic differential includes:
•Airways •Alveoli •Interstitium •Vascular •Pleura •Chest wall •Extrathoracic
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
- –Inadequate ventilation
- –Nocturnal hypoventilation
- –Weak cough
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.
- 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.
Neuromuscular diseases (acute, relapsing, chronic)
•Acute: Guillain-Barre (GBS)
•Relapsing: Multiple sclerosis (MS), myasthenia gravis (MG)
•Chronic, progressive: ALS
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
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
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
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
Pulmonary manifestations of IBD
- •Tracheobronchitis
-
•Bronchiectasis ==> obstructive
- •Bronchiolitis ==> obstrutive
- •Pleural Effusion ==> restrictive
- •Interstitial Lung Disease ==> restrictive
- •Pulmonary embolism
- •Drug complications
- •Infections
Common types of Obstructive disease
–Tracheobronchitis
–Bronchiectasis
–Bronchiolitis
Common Types of Restrictive Disease
–Pleural Effusion
–Interstitial Lung Disease
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
Pulmonary complications in HIV (infectious)
•Bacterial pneumonia
•Tuberculosis
•Pneumocystis jirovecii (PCP)
•Fungal pneumonia
•Viral pneumonia
Pulmonary complications in HIV (noninfectious)
•Kaposi’s sarcoma
•Non-Hodgkin’s lymphoma
•Lung cancer
•Emphysema
•ILD
•Pulmonary HTN
•Effusions –Parapneumonic –TB –Malignant; esp lymphoma
