ct: interstitial lung disease
TRANSCRIPT
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PHYSICIANS’ MEET09.04.2009
Prof. S.SUNDAR’s unit
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AN INTERESTING C.T.
Dr.N. Arun Kumar
Prof. S.SUNDAR’s unit
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• Dhanushkodi, an 84 year old male Pt. got admitted in urology department as a case of BPH.
• h/o breathlessness on exertion +• vitals normal• ECG- WNL• ECHO- Normal Study• CXR- reticulo nodular pattern involving lower
zones of both the lungs•
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HRCT FEATURES
LUNG PARENCHYMA- • bilateral diffuse interlobular septal thickening with
ground-glass opacities. • Honeycomb changes in both the lung fields.
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IMPRESSION
INTERSTITIAL LUNG DISEASE- ? Idiopathic Pulmonary Fibrosis
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INTERSTITIAL LUNG DISEASE Exertional dyspnoea Persistent, non productive cough Hemoptysis, wheezing, chest pain Involvement of parenchyma of the lung alveoli alveolar epithelium capillary endothelium perivascular tissues lymphatic tissues
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CHEST ROENTGENOGRAPHIC FINDINGS
Bibasilar reticular pattern Nodular/mixed pattern of alveolar fillings &
increased reticular markings Nodular opacities with predilection of upper lung
zones sarcoidosis PLCH Chronic Hypersensitivity Pneumonitis silicosis berylliosis RA Ankylosing Spondylitis
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Contd…
Basal reticular opacities –often visible on CXR even several years before the development of symptomsCXR correlates poorly with clinical/HP stage of the disease CXR finding of honeycombing- pathologic findings of cystic spaces & progressive fibrosis (poor prognosis) CXR is nonspecific
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COMPUTED TOMOGRAPHY
HRCT is superior to CXR Better assessment of the extent & distribution of
the disease useful in patients with normal CXR Co-existing disease- best recognized by HRCT –
mediastinal adenopathy, carcinoma, emphysema HRCT- to preclude the need of lung biopsy in IPF,
sarcoidosis, hypersensitivity pneumonitis, asbestosis, lymphangitic carcinoma, PLCH
Determination of the most appropriate area from which biopsy samples should be taken
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RESPIRATORY SYMPTOMS & SIGNS Dyspnoea In some patients with sarcoidosis extensive parenchymal silicosis lung ds.on CXR without PLCH significant dyspnoea Hs.Pneumonitis
Wheezing
clinically significant chest pain uncommon Hemoptysis
fatigue & weight loss
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SYSTEMIC EXAMINATION OF RS
• Tachypnoea• Bi-basilar end inspiratory dry crackles• Crackles may present in the absence of CXR
findings• Scattered late inspiratory high-pitched rhonchi
(inspiratory squeaks) in bronchiolitis• In mid & late stages of disease- Pulm.HTN & Cor
Pulmonale• Cyanosis & clubbing- in advanced disease
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ATYPICAL FINDINGS IN HRCT
• Extensive ground-glass abnormalities
• Nodular opacities
• Upper zone/Middle zone predominance
• Prominent hilar/mediastinal lymphadenopathy
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DIFFERENTIAL DIAGNOSES• Connective Tissue Diseases (scleroderma, RA)• Asbestosis (parenchymal bands of fibrosis & pleural plaques)• Subacute/chronic hypersensitivity pneumonitis (lack the bibasilar
predominence seen in IPF)• Sarcoidosis• Desquamative Interstitial Pnemonitis extensive ground-
• Respiratory bronchiolitis glass opacity
• Hypersensitivity Pneumonitis without basal or
• Idiopathic BOOP peripheral
• Non-Specific Interstitial Pneumonitis (NSIP) predominence
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Contd…
• Lymphangitic Carcinomatosis • Cardiogenic Pulmonary Edema reticular pattern• Alveolar Proteinosis• Miliary TB • PLCH nodular pattern• Respiratory Bronchiolitis• Cryptogenic Organizing Pneumonia• Lymphangiomyomatosis • Centrilobular Emphysema
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THANK U