INTERSTITIAL LUNG DISEASE

Esam H. Alhamad, M.DAssistant Professor of Medicine

Consultant Pulmonary & Critical Care Medicine

ATS/ERS. Am J Respir Crit Care Med 2002;165:277-3

SMOKING ASSOCIATED INTERSTITIAL LUNG DISEASE

Desquamative Interstitial Pneumonia (DIP)

• Liebow 1965• DIP desquamation of epithelial cells?, but the

main histopathologic finding is accumulation of macrophages within alveolar space

• 90% smoked or had smoked cigarettes• May occasionally be seen with CTD, and drug

induced lung disease

DIP: SURVIVALNicholson et al. Am J Respir Crit Care Med 2000;162:2213-2217

Desquamative Interstitial Pneumonia DIPClinical Features

• Young adult, average 40-50 yr• Men > women• Dyspnea 87% Cough 43%• Inspiratory crackles 57%• Digital clubbing 26%• Pulmonary function: Restrictive 30%, Obstructive

15%, Dlco 35%, Normal 20%

Ryu et al. Chest 2005;127:178-184

Desquamative Interstitial Pneumonia DIPHRCT

• Ground glass opacities 83%• Bilateral reticular opacities 17%• Patchy consolidation 6%• Honeycombing rare

Desquamative Interstitial Pneumonia DIP

HRCT: Contrasting DIP with UIP

DIP: Treatment and Outcome

• Prognosis is generally good, average survival 12 yrs (Carrington et al. Nengl J Med 1978;298:801-809)

• Spontaneous improvement has been reported• Corticosteroids and smoking cessation seems to be

effective, immunosuppresive agents?• Late relapse and recurrence in transplanted lung has

been reported• Progression to respiratory failure is uncommon

Respiratory Bronchiolitis Associated Interstitial Lung Disease (RB-ILD)

• Extremely common histopathologic lesion in cigarette smoker

• Slight male predominance• Dyspnea, cough• Inspiratory crackles 42%• Digital clubbing 25%

Ryu et al. Chest 2005;127:178-184

RB-ILD SURVIVALNicholson et al. Am J Respir Crit Care Med 2000;162:2213-2217

RB-ILD: HRCT findings

• Ground glass opacities 100%• Centrilobular nodules are common• Associated emphysematous changes may

occur• Honeycombing is rare

• What is the most common misdiagnosis given to patients with hypersensitivity pneumonitis?

• Bacterial or viral pneumonia

• What are the symptoms seen in acute hypersensitivity pneumonitis which occour four to six hours after antigen exposure?

• Fever, chills, dyspnea, and malaise

• What physical findings are seen in acute hypersensitivity pneumonitis?

• Fever, pulmonary crackles, possibly cyanosis

• What is the most common physical abnormality in subacute disease?

• Diffuse crackles

• Where are the infiltrates in hypersensitivity pneumonitis?

• Usually bilateral and equally distributed (involving the upper lobes)

• What is the chest x-ray findings in the early stages of the disease?

• Within normal limit

• What is the chest x-ray finding in chronic disease?

• Diffuse interstitial fibrosis

• What is the classic PFT abnormality in hypersensitivity pneumonitis?

• Restrictive pattern

• What is the main cause of respiratory disability in patients with hypersensitivity pneumonitis?

• Pulmonary fibrosis

• Which patient is least likely to have IPF:A 30 year old man, a 50 year old woman, or a 70

year old man?

30 year old man, IPF most commonly diagnosed in individuals between the ages of 40-70 years

• Approximately 60% of patients with IPF have what extremity findings?

• Clubbing

• What is the most common cause of death in patients with IPF?

• Respiratory failure

THANK YOU