Session 16: Respiratory Diseases

Question 1

DDx of Micronodular shadowing on CXR

Answer 1

1. Lymphangitis carcinomatosis
2. Miliary TB
3. Silicosis
4. Sarcoidosis
5. Pulmonary haemosiderosis

Question 2

CXR Hidden areas

Answer 2

1. Lung apex
2. Costophrenic angles
3. Diaphragm (make use of gastric bubble)
4. Retrocardiac shadow
5. Small pneumothorax
6. Miliary shadows
7. Asymmetrical hypertranslucency (e.g. mastectomy)

Question 3

Causes of SOB in SLE patients

Answer 3

Respiratory:
1. Pleural effusion
2. Infective pneumonia (esp. on steroids / immunosuppressants)
3. ILD (due to SLE)
4. COP (Cryptogenic organizing pneumonia) / BOOP (Bronchiolitis obliterans with organizing pneumonia)
5. Shrinking lung syndrome (rising diaphragm; neuromuscular / myopathy)

Cardiac:
1. Pericardial effusion
2. Myocarditis
3. Hypertensive heart disease (HT due to uraemia / steroid)
4. Ischaemic heart disease (arteritis of coronary artery)

Vascular:
1. Pulmonary embolism
2. Pulmonary hypertension
3. Fluid retention

Anaemia:
1. Anaemia of chronic disease
2. Pancytopenia (due to SLE)
3. Haemolytic anaemia
4. Uraemia
5. GI bleed (due to NSAID / steroid)
6. BM suppression (due to immunosuppressants e.g. Azathioprine)