Inhalation Lung Diseases

Front 1

Diffuse Parenchymal Lung Disease (Interstial Lung disease)

Back 1

Idiopathic interstitial lung pnumonias are the most common. They inclue UIPs, NSIP, BOOP, and DIP

Front 2

Non-specific interstitial pneumonia

Back 2

-More homogenous
-no honeycombing

Front 3

Bronchiolitis obliterans organized pneumonia

Back 3

-Plugs of fibroblasts in airways
-CT shows areas of consolidation

Front 4

Desquamative Interstitial Pneumonia

Back 4

-Alveolar spaces filled with alveolar macrophages
-Cigarete smoking related
-No desquamation
-Ground glass opacifications on CT

Front 5

Hypersensitivity Pneumonitis

Back 5

-Only disease caused by inhalation of organic particles
-Abnormal immunological reaction of the lung to specific organic antigens
-Size and amount of particle are key factors
-Thermophilic actinomycetes, fungi, and bird droppings are the most common causes

Front 6

Pathogenesis of hypersensitivity pneumonitis

Back 6

antigen exposure ->accumulation of inflammatory cells ->lymphocytic alveolitis in more chronic phases -> granuloma formation -> normal repair or end up with fibrosis from continued antigen exposure

Front 7

someone presents with acute fever, chills, dyspnea, cough. chest xray shows infiltrates

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Could be hypersensitivity pneumonitis.
-High resolution CT shows a lot of "ground glass opacifications"

Front 8

Subacute Hypersensitivity presentation

Back 8

Symptoms evolve over weeks to months

Front 9

Chronic hypersensitivity pneumonitis presentation

Back 9

Same as IPF.
-persistent cough, shortness of breath, sputum production
-HRCT may show fibrotic changes

Front 10

Diagnosis of Hypersensitivity pneumonitis

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-Careful H&P
-PFTs show restrictive pattern
-Diffusion impairment and hypoxemia
-Imaging acutely shows ground glass opacifications and chronically shows more fibrotic tissue
-May have serum precipitating antibodies
-Lung biopsy is the gold standard. Will show honeycombing in lower lungs in chronic

Front 11

Shipbuilder, construction, automotive, railroad

Back 11

Think Asbestosis!
-Asbestos is a naturally occuring minral with therm-insulating properties

Front 12

What can asbestos do?

Back 12

Induces pleural disease, malignant mesothelioma, bronchogenic cancer, and asbestosis

-98% is the more benign chrysotile fiber

Front 13

Define Asbestosis

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-Interstitial pneumonitis and fibrosis caused by exposure to asbestos fibers. The prevalence increase with duration and intensity of exposure.

-LATENCY PERIOD OF 15-20 YRS
-Most cases are progressive

Front 14

Describe the pathogenesis of asbestosis

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-Direct toxic effects
-Release of mediators by inflammatory cells causes more inflammatory cells, fibroblast proliferation, and loss of type I and II pneumocytes

Front 15

Clinical findings of asbestosis

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-Progressive Dyspnea
-Bibasilar inspiratory crackels
-clubbing of fingernails
-PFTs show restriction and low DLCO

-can have honeycomb appearance

Front 16

Radiographic findings of Asbestosis

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-Pleural plaques
-Round atelectasis
-Basilar disease
-interlobar septal fibrosis and honeycombing in advanced cases

Front 17

How do you diagnose asbestosis?

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-Reliable history of exposure with latency period
-Evidence of interstitial fibrosis
-Asbestos fibers or bodies in biopsy are helpful but not necessary

Front 18

Foundry work, tunneling, sandblasting, pottery making, manufacturers of brink, tiles, glass

Back 18

Silicosis!
-Chronic fibrosis disease of the lungs caused by inhalation of free silica dust

Front 19

Acute silicosis

Back 19

presents like ARDS. from massive exposure

Front 20

Chronic or Simple Silica exposure

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More like IPF with chronic cough and dyspnea. Caused by exposure to low concentrations for 20 yrs or more

Front 21

Pathogenesis of Silicosis

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alveolar macrophages eat silica, get activated, release inflammatory mediators, and cause inflammation and fibrosis

Front 22

Someone comes in asymptomatic and you discover an abnormal chest xray and then restricted PFTs

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Think silicosis. Usually it is asymptomatic. 10-15% go on to develop "progressive massive fibrosis"

On CXR, there a upper zone micronodular opacities

Front 23

Diagnosis of Silicosis

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-History of exposure
-Absence of other illnesses
-Reticulo-nodular and nodular infiltrates
-Upper lobe predominance

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Associated illnesses with silicosis

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-Mycobacterial infections (TB)
-Connective Tissue Disease like Scleroderma
-Lung Cancer

Front 25

Coal workers pneumoconiosis

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-exposure to coal dust and silica
-asymptomatic, small nodual opacities on CXR- ALL OVER
-Need history of exposure and CXR to diagnose
-Doesn't usually go to end stage lung disease

Front 26

ILD is associated with what?

Back 26

Connective Tissue Diseases
-unknown etiology
-most associated with scleroderma and rheumatoid arthritis and least with lupus
-The CTD probably causes the ILD in many cases

Front 27

Discuss Rheumatoid arthritis

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-Chronic symmetric polyarthritis, usually insidious onset with fatigue, loss of appetite, vague aches and pains, morning stiffness
-joint deformities
-bone erosion with sinovitis
-soft tissue around joints is swollen
-Subcutaneous nodules

Front 28

ILD caused by RA

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-more common in men
-infiltrates at bases
-mean survival 5 yrs
-might respond to steroids
-honeycomb

Front 29

Discuss Systemic Sclerosis

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-Accumulation of connective tissue in skin and visceral organs
-Diffuse cutaneous vs limited cutaneous (CREST)
-Diffuse think antitopoisomerase
-Limited think anticentromere Ab
-Pulmonary HTN predicts a poor prognosis

Front 30

"Friends say I look younger every day" or I have trouble swallowing

Back 30

Think scleroderma

Front 31

ILD related to Scleroderma

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-Lung impairment in most patients
-Usually in base of lungs
-Lung disease is most common cause of death with scleroderma
-High risk of bronchogenic cancer too
Teat with cyclophoshamide

Front 32

Reddish discolored knuckles (Gottron's sign)

Back 32

Dermatolysis

Front 33

Sicca Syndrome (dry and red eyes and dry mouth)

Back 33

Sjorgens

Front 34

Drug-induced ILD

dyspnea, fever, infiltrates are the usual presentation

Back 34

Bleomycin- dose dependent
Cyclophosphamide/methotrexate- time dependent

Amiodarone (anitarrythmia)
-DLCO of more than 80% virtually excludes it