Interstitial lung disease PDF
Preview Interstitial lung disease
Interstitial lung disease Deepak Aggarwal Dept of Pulmonary Medicine Government Medical College and Hospital, Chandigarh What is Interstitium • The interstitial space is defined as continuum of loose connective tissue throughout the lung • It is the tissue between the air sacs of the lungs Subdivisions of lung interstitium Axial interstitium (peribronchovascular) Centrilobular interstitium peripheral interstitium Surrounding the bronchi, situated between the alveolar contains the pulmonary arteries, and veins from the and capillary basement venules, lymphatics and lung root to the level of the membranes interlobular septae respiratory bronchiole; • Centrilobular bronchus (single wide white arrow) and artery (double white arrow, 1-mm size) • Interlobular septa (single arrowhead,0.1-mm thickness) • Pulmonary vein (double arrowheads,0.5-mm size) • Visceral pleura (single black arrow, 0.1-mm thickness) • pulmonary acinus (single thin white arrow,5– 10 mm size Introduction • There are >200 disorders • Can classified into – known vs unknown with subcategory of granulomatous and nongranulomatous. OR – occupational vs nonoccupational – Acute vs Chronic ILD Classification Approach to ILD Idiopathic Granulomatous ILD of known Interstitial Lung Diseases Others Cause Pneumonias (Sarcoidosis) LAM Drugs Exposure CVD IPF IIP other than IPF HistiocytosisX Malignancy Respiratory Desquamative Hypersensitivity Bronchiolitis- Pneumoconiosis Interstitial Pneumonitis Interstitial Lung Pneumonia disease Cryptogenic Acute Interstitial Organizing Toxic Inhalation Radiation Pneumonia Pneumonia Lymphocytic Non Specific Interstitial Interstitial Pneumonia Pneumonia Classification of idiopathic interstitial pneumonia Classification Interstitial Lung Diseases Sarcoidosis UIP/IPF Fibrosis Hypersensitivity Pneumonitis AIP “IIP” 1970s 2007 LIP COP Asbestosis Cellular LAM NSIP Fibrotic etc IPs=Interstitial pneumonias LAM=lymphangioleiomyomatosis RB- DIP Adapted from Ryu JH, et al. Mayo Clin Proc. 1998;73:1085-1101. ILD Inflammation Adapted from ATS/ERS. Am J Respir Crit Care Med. 2002;165:277-304. Distribution Occupation 11% DILD Sarcoidosis 5% DAH 8% 4% CTD 9% Other 11% Pulmonary Fibrosis 52% Common features in ILD – Dyspnea – Diffuse disease on X ray • Often the first suggestion of disease but correlates poorly with severity of disease – Restrictive PFTs • Restrictive intrathoracic pattern: Normal airway flow rates but low FVC – Elevated A-a gradients
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