4/17/2010 C ini n ca c l a Ev E a v l a ua u t a ion o n of o ILD U dat a e t e i n I LDs

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "4/17/2010 C ini n ca c l a Ev E a v l a ua u t a ion o n of o ILD U dat a e t e i n I LDs"

Transcription

1 Update in ILDs Diagnosis 101: Clinical Evaluation April 17, 2010 Jay H. Ryu, MD Mayo Clinic, Rochester MN Clinical Evaluation of ILD Outline General aspects of ILDs Classification of ILDs Clinical evaluation of ILDs Diagnostic approach Illustrative case Summary References When to consider ILD: Diffuse lung infiltrates on CXR or CT Restrictive pulmonary dysfunction Isolated reduction in DL CO or exercise-induced induced desaturation Unexplained chronic dyspnea and/or cough, crackles Underlying systemic disease or other risk factors, e.g. exposures General Concepts Diffuse infiltrative disease affecting the lung parenchyma Many clinicopathologic entities included; heterogeneous category No universally accepted classification of ILDs 1

2 Classification of ILDs Potential parameters for classification Clinical presentation, e.g. acute vs. chronic Histopathologic findings Radiologic pattern Responsiveness to corticosteroids Cause - known vs. unknown (ATS/ERS. AJRCCM 2002) Known Cause Connective tissue diseases Environmental & occupational exposures Drugs Smoking (RB-ILD/DIP, Pulmonary Langerhans Cell Histiocytosis, AEP) Radiation Unknown Cause IPF Other interstitial pneumonias (COP, NSIP, LIP, AIP) Sarcoidosis Eosinophilic pneumonias Vasculitis LAM, PAP, etc. (Ryu et al. Mayo Clin Proc 2007) Potential Mimics Infections Neoplasms Bronchiectasis and bronchiolitis Pulmonary edema (CHF, ARDS) Pulmonary hemorrhage Neuromuscular diseases Aspiration, etc 2

3 Diagnosis n % of total % Bx proven Sarcoidosis IPF/UIP CTD-ILDs HP Other IIPs Undefined fibrosis Total n = 315 (Thomeer et al. Respir Med 2004) Diagnostic Evaluation History, physical examination Chest x-ray CBC, chemistry panel, urinalysis High-resolution CT chest PFTs Additional selective testing: HP serology, connective tissue disease serology, ANCA, anti-gbm Ab, BNP, echocardiography Lung biopsy (bronchoscopy, VATS/thoracotomy) History Demographics Exposures: smoking, drugs, occupational, environmental Previous and concurrent illnesses Familial disorders Clinical manifestations Tempo of the process Physical Examination Lung auscultation Digital clubbing Extrapulmonary signs Pulmonary Function Testing Usually, restrictive defect with reduced lung volumes (TLC, VC), reduced diffusing capacity, and normal FEV1/FVC ratio Obstructive or mixed defect - pulmonary Langerhans cell histiocytosis, LAM, sarcoidosis, Wegener s granulomatosis, ILD with underlying COPD/emphysema, associated pleural disease or chest wall disorder Normal or isolated diffusion abnormality - early interstitial lung diseases 3

4 Diagnostic Evaluation 3 Pivotal Parameters: Clinical context Tempo of the disease process (acute, subacute, chronic) Radiologic pattern Pattern of opacities Distribution Associated findings INTERSTITIAL LUNG DISEASES HRCT Findings Pattern of parenchymal infiltrates: reticular, nodular, ground-glass/consolidation, glass/consolidation, cystic Distribution: diffuse vs localized, peripheral vs central, upper vs lower, bronchovascular bundle Associated abnormalities: traction bronchiectasis, mosaic pattern, pleural disease, adenopathy, etc. Diagnostic Evaluation of ILD Clinical context Tempo (history, examination, labs, CXRs, PFTs) High-resolution CT Chest (pattern, distribution, associated features) Specific Diagnosis Further Testing Biopsy? Diagnosis A category sufficiently distinct to establish: Prognosis Therapeutic/management action or both 4

5 Diagnostic Testing Purpose Arrive at a diagnostic category that will establish a prognosis, dictate a therapeutic action, or both Reduce clinical uncertainty Lung Biopsy Histopathologic features have varying disease specificity. Histopathologic pattern alone may not suffice for a diagnosis. Correlation with clinical & radiologic context is a must in ILDs. Case Presentation 58M ex-smoker (quit 30 yr ago), real estate developer, referred 5/05 for IPF management. Chronic persistent cough x 4 yr, slowly progressive exertional dyspnea. CT chest abnormal; VATS biopsy 4/05 showed UIP. 2 episodes of pneumonias past 6 mo. No relevant occupational or environmental exposures. PMH: depression, hypercholesterolemia, obesity Medications: omeprazole, fenofibrate Case Presentation 58M 3/05 Physical exam: BMI 27, bibasilar Velcro crackles, VATS scar, mild clubbing. PFT: abnormal, mild restriction TLC 65% pred FVC 50% pred FEV1 52% pred FEV1/FVC 82.3 DLCO 40% pred 5

6 VATS Lung Biopsy VATS Lung Biopsy Case Follow-up Diagnosis: IPF/UIP. Treatment: N-acetylcysteine. Lung transplant evaluation. July 2005 (3 mo later), hospitalized for fever, hemoptysis, lung infiltrates, microscopic hematuria. P-ANCA positive (MPO Ab 60.1, NL <6), c-anca negative. Treated with IV methylprednisolone, then prednisone 60 mg/d & cyclophosphamide 150 mg/d. Hospitalized x 2 ½ wk. Gradual improvement. DIAGNOSIS: : UIP with microscopic polyangiitis (not IPF) 58M 3/05 11/06 6

7 % predicted UIP Microscopic Polyangiitis Months TLC FVC DLCO Usual Interstitial Pneumonia Idiopathic (IPF) Known cause or underlying disease: Connective tissue diseases, vasculitis Chronic hypersensitivity pneumonitis Asbestosis Drugs Genetic disorders - familial pulmonary fibrosis, Hermansky-Pudlak, dyskeratosis congenita, ABCA3 gene mutation, telomerase mutations Others - infections, aspiration, pulmonary artery sarcoma, etc. SUMMARY ILDs are heterogeneous, diffuse infiltrative diseases of known and unknown causes, affecting the lung parenchyma. Clinical context, tempo of the disease process, and HRCT pattern are the pivotal parameters in the diagnostic process. Accurate diagnosis of ILDs requires judicious clinico-radiologic-pathologic correlation. References Leslie KO. My approach to interstitial lung disease using clinical, radiological and histopathological patterns. J Clin Pathol 2009;62: Ryu JH, Daniels CE, Hartman TE, Yi ES. Diagnosis of interstitial lung diseases. Mayo Clin Proc 2007;82: Collard HR, King TE Jr. Demystifying idiopathic interstitial pneumonia. Arch Intern Med 2003;163: American Thoracic Society/European Respiratory Society International Multidisciplinary Consensus Classification of the Idiopathic Interstitial Pneumonias. Am J Respir Crit Care Med 2002;165:

INTERSTITIAL LUNG DISEASE. Radhika Reddy MD Pulmonary/Critical Care Long Beach VA Medical Center January 5, 2018

INTERSTITIAL LUNG DISEASE. Radhika Reddy MD Pulmonary/Critical Care Long Beach VA Medical Center January 5, 2018 INTERSTITIAL LUNG DISEASE Radhika Reddy MD Pulmonary/Critical Care Long Beach VA Medical Center January 5, 2018 Interstitial Lung Disease Interstitial Lung Disease Prevalence by Diagnosis: Idiopathic Interstitial

More information

A Review of Interstitial Lung Diseases. Paul J. Wolters, MD Associate Professor Department of Medicine University of California San Francisco

A Review of Interstitial Lung Diseases. Paul J. Wolters, MD Associate Professor Department of Medicine University of California San Francisco A Review of Interstitial Lung Diseases Paul J. Wolters, MD Associate Professor Department of Medicine University of California San Francisco Outline Overview of diagnosis in ILD Why it is important Definition/Classification

More information

Outline Definition of Terms: Lexicon. Traction Bronchiectasis

Outline Definition of Terms: Lexicon. Traction Bronchiectasis HRCT OF IDIOPATHIC INTERSTITIAL PNEUMONIAS Disclosures Genentech, Inc. Speakers Bureau Tadashi Allen, MD University of Minnesota Assistant Professor Diagnostic Radiology 10/29/2016 Outline Definition of

More information

Diffuse Interstitial Lung Diseases: Is There Really Anything New?

Diffuse Interstitial Lung Diseases: Is There Really Anything New? : Is There Really Anything New? Sujal R. Desai, MBBS, MD ESTI SPEAKER SUNDAY Society of Thoracic Radiology San Antonio, Texas March 2014 Diffuse Interstitial Lung Disease The State of Play DILDs Is There

More information

DIAGNOSTIC NOTE TEMPLATE

DIAGNOSTIC NOTE TEMPLATE DIAGNOSTIC NOTE TEMPLATE SOAP NOTE TEMPLATE WHEN CONSIDERING A DIAGNOSIS OF IDIOPATHIC PULMONARY FIBROSIS (IPF) CHIEF COMPLAINT HISTORY OF PRESENT ILLNESS Consider IPF as possible diagnosis if any of the

More information

Progress in Idiopathic Pulmonary Fibrosis

Progress in Idiopathic Pulmonary Fibrosis Progress in Idiopathic Pulmonary Fibrosis David A. Lynch, MB Disclosures Progress in Idiopathic Pulmonary Fibrosis David A Lynch, MB Consultant: t Research support: Perceptive Imaging Boehringer Ingelheim

More information

Interstitial Lung Disease (ILD)

Interstitial Lung Disease (ILD) Interstitial Lung Disease (ILD) ILD comprises more than 130 distinct disorders Characterized by cellular proliferation, cellular infiltration, and/or fibrosis of the lung parenchyma not due to infection

More information

Epidemiology and classification of smoking related interstitial lung diseases

Epidemiology and classification of smoking related interstitial lung diseases Epidemiology and classification of smoking related interstitial lung diseases Šterclová M. Department of Respiratory Diseases, Thomayer Hospital, Prague, Czech Republic Supported by an IGA Grant No G 1207

More information

New Horizons in the Diagnosis & Management of Idiopathic Pulmonary Fibrosis (IPF) CME Learning Objectives

New Horizons in the Diagnosis & Management of Idiopathic Pulmonary Fibrosis (IPF) CME Learning Objectives New Horizons in the Diagnosis & Management of Idiopathic Pulmonary Fibrosis (IPF) Improving Outcomes in IPF Leann Silhan, MD 1 CME Learning Objectives Assess and apply guideline recommendations for the

More information

Disclosures. Traditional Paradigm. Overview 4/17/2010. I have relationships with the following organizations and companies:

Disclosures. Traditional Paradigm. Overview 4/17/2010. I have relationships with the following organizations and companies: Disclosures Pharmacological Therapy for ILD What to Use and How to Use It Harold R Collard MD Interstitial Lung Disease Program University of California San Francisco (UCSF) I have relationships with the

More information

Radiologic Approach to Smoking Related Interstitial Lung Disease

Radiologic Approach to Smoking Related Interstitial Lung Disease Radiologic Approach to Smoking Related Interstitial Lung Disease Poster No.: C-1854 Congress: ECR 2013 Type: Educational Exhibit Authors: K.-N. Lee, J.-Y. Han, E.-J. Kang, J. Kang; Busan/KR Keywords: Toxicity,

More information

UIP Possibile e Probabile

UIP Possibile e Probabile UIP Possibile e Probabile Sergio Harari U.O. di Pneumologia e UTIR Servizio di Emodinamica e Fisiopatologia Respiratoria Ospedale San Giuseppe - Milano Current definition of IPF IPF is a distinct type

More information

Bronchoalveolar Lavage and Histopathologic Diagnosis Based on Biopsy

Bronchoalveolar Lavage and Histopathologic Diagnosis Based on Biopsy Idiopathic Pulmonary Fibrosis Bronchoalveolar Lavage and Histopathologic Diagnosis Based on Biopsy JMAJ 46(11): 469 474, 2003 Yukihiko SUGIYAMA Professor, Division of Pulmonary Medicine, Department of

More information

Combined Unclassifiable Interstitial Pneumonia and Emphysema: A Report of Two Cases

Combined Unclassifiable Interstitial Pneumonia and Emphysema: A Report of Two Cases CASE REPORT Combined Unclassifiable Interstitial Pneumonia and Emphysema: A Report of Two Cases Nobuhiko Nagata 1, Kentaro Watanabe 2, Michihiro Yoshimi 3, Hiroshi Okabayashi 4, Katsuo Sueishi 5, Kentaro

More information

Acute and Chronic Lung Disease

Acute and Chronic Lung Disease KATHOLIEKE UNIVERSITEIT LEUVEN Faculty of Medicine Acute and Chronic Lung Disease W De Wever, JA Verschakelen Department of Radiology, University Hospitals Leuven, Belgium Clinical utility of HRCT To detect

More information

Idiopathic Pulmonary Fibrosis: The Importance of Qualitative and Quantitative Phenotyping

Idiopathic Pulmonary Fibrosis: The Importance of Qualitative and Quantitative Phenotyping Idiopathic Pulmonary Fibrosis: The Importance of Qualitative and Quantitative Phenotyping K. R. Flaherty Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor,

More information

ERS 2016 Congress Highlights Interstitial Lung Disease (ILD)

ERS 2016 Congress Highlights Interstitial Lung Disease (ILD) ERS 216 Congress Highlights Interstitial Lung Disease (ILD) London, UK September 3 rd 7 th 216 The 26 th European Respiratory Society International Congress, (ERS) the largest respiratory meeting in the

More information

Lung Function Basics of Diagnosis of Obstructive, Restrictive and Mixed Defects

Lung Function Basics of Diagnosis of Obstructive, Restrictive and Mixed Defects Lung Function Basics of Diagnosis of Obstructive, Restrictive and Mixed Defects Use of GOLD and ATS Criteria Connie Paladenech, RRT, RCP, FAARC Benefits and Limitations of Pulmonary Function Testing Benefits

More information

Systemic lupus erythematosus (SLE): Pleuropulmonary Manifestations

Systemic lupus erythematosus (SLE): Pleuropulmonary Manifestations 08/30/10 09/26/10 Systemic lupus erythematosus (SLE): Pleuropulmonary Manifestations Camila Downey S. Universidad de Chile, School of Medicine, Year VII Harvard University, School of Medicine Sept 17,

More information

Challenges in the Diagnosis of Interstitial Lung Disease

Challenges in the Diagnosis of Interstitial Lung Disease Challenges in the Diagnosis of Interstitial Lung Disease Kirk D. Jones, MD UCSF Dept. of Pathology kirk.jones@ucsf.edu Overview New Classification of IIP Prior classification Modifications for new classification

More information

June 2013 Pulmonary Case of the Month: Diagnosis Makes a Difference. Lewis J. Wesselius, MD 1 Henry D. Tazelaar, MD 2

June 2013 Pulmonary Case of the Month: Diagnosis Makes a Difference. Lewis J. Wesselius, MD 1 Henry D. Tazelaar, MD 2 June 2013 Pulmonary Case of the Month: Diagnosis Makes a Difference Lewis J. Wesselius, MD 1 Henry D. Tazelaar, MD 2 Departments of Pulmonary Medicine 1 and Laboratory Medicine and Pathology 2 Mayo Clinic

More information

Nintedanib and Pirfenidone: New Medications in the Management of Idiopathic Pulmonary Fibrosis

Nintedanib and Pirfenidone: New Medications in the Management of Idiopathic Pulmonary Fibrosis Nintedanib and Pirfenidone: New Medications in the Management of Idiopathic Pulmonary Fibrosis Brad Zimmermann, PharmD, MBA Pharmacy Grand Rounds May 02, 2017 Rochester, Minnesota 2017 MFMER slide-1 Objectives

More information

Interstitial Lung Diseases(ILD) By : Dr. Shaher M. Samrah Done by : Ibrahim M. sun

Interstitial Lung Diseases(ILD) By : Dr. Shaher M. Samrah Done by : Ibrahim M. sun Interstitial Lung Diseases(ILD) By : Dr. Shaher M. Samrah Done by : Ibrahim M. sun. 26.11.11 Introduction Interstitial Lung Diseases (ILD) are group of diseases that affect the interstitium of the lungs,

More information

Careful histopathological evaluation has shown the traditionally clinical diagnosis of

Careful histopathological evaluation has shown the traditionally clinical diagnosis of Demystifying Idiopathic Interstitial Pneumonia Harold R. Collard, MD; Talmadge E. King, Jr, MD REVIEW ARTICLE Careful histopathological evaluation has shown the traditionally clinical diagnosis of idiopathic

More information

Pulmonary Function Testing The Basics of Interpretation

Pulmonary Function Testing The Basics of Interpretation Pulmonary Function Testing The Basics of Interpretation Jennifer Hale, M.D. Valley Baptist Family Practice Residency Objectives Identify the components of PFTs Describe the indications Develop a stepwise

More information

Cryptogenic Organizing Pneumonia: Serial High-Resolution CT Findings in 22 Patients

Cryptogenic Organizing Pneumonia: Serial High-Resolution CT Findings in 22 Patients Cardiopulmonary Imaging Original Research Lee et al. High-Resolution CT of Cryptogenic Organizing Pneumonia Cardiopulmonary Imaging Original Research Ju Won Lee 1 Kyung Soo Lee 1 Ho Yun Lee 1 Man Pyo Chung

More information

An earlier and more confident diagnosis of idiopathic pulmonary fibrosis

An earlier and more confident diagnosis of idiopathic pulmonary fibrosis Eur Respir Rev 2012; 21: 124, 141 146 DOI: 10.1183/09059180.00000812 CopyrightßERS 2012 REVIEW: IPF An earlier and more confident diagnosis of idiopathic pulmonary fibrosis Roland M. du Bois ABSTRACT:

More information

PFF HEALTH CARE PROFESSIONAL WEBINAR SERIES. Welcome!

PFF HEALTH CARE PROFESSIONAL WEBINAR SERIES. Welcome! PFF HEALTH CARE PROFESSIONAL WEBINAR SERIES Welcome! AGENDA TOPICS Welcome & Introduction Dr. Gregory Cosgrove, MD Chief Medical Officer Pulmonary Fibrosis Foundation PFF Resources Dolly Kervitsky, RCP,

More information

Thoracic lung involvement in rheumatoid arthritis: Findings on HRCT

Thoracic lung involvement in rheumatoid arthritis: Findings on HRCT Thoracic lung involvement in rheumatoid arthritis: Findings on HRCT Poster No.: C-2488 Congress: ECR 2015 Type: Educational Exhibit Authors: R. E. Correa Soto, M. J. Martín Sánchez, J. M. Fernandez 1 1

More information

Diagnostic Approach to Advanced Fibrotic Interstitial Lung Disease. Bringing Together Clinical, Radiologic, and Histologic Clues

Diagnostic Approach to Advanced Fibrotic Interstitial Lung Disease. Bringing Together Clinical, Radiologic, and Histologic Clues Diagnostic Approach to Advanced Fibrotic Interstitial Lung Disease Bringing Together Clinical, Radiologic, and Histologic Clues Brandon T. Larsen, MD, PhD; Maxwell L. Smith, MD; Brett M. Elicker, MD; Jessica

More information

Idiopathic pulmonary fibrosis (IPF) is a

Idiopathic pulmonary fibrosis (IPF) is a Eur Respir J 2011; 38: 176 183 DOI: 10.1183/09031936.00114010 CopyrightßERS 2011 Pulmonary function measures predict mortality differently in IPF versus combined pulmonary fibrosis and emphysema S.L. Schmidt*,

More information

Colchicine versus Prednisone in the Treatment of Idiopathic Pulmonary Fibrosis A Randomized Prospective Study

Colchicine versus Prednisone in the Treatment of Idiopathic Pulmonary Fibrosis A Randomized Prospective Study Colchicine versus Prednisone in the Treatment of Idiopathic Pulmonary Fibrosis A Randomized Prospective Study WILLIAM W. DOUGLAS, JAY H. RYU, STEPHEN J. SWENSEN, KENNETH P. OFFORD, DARRELL R. SCHROEDER,

More information

Focal Organizing Pneumonia on Surgical Lung Biopsy* Causes, Clinicoradiologic Features, and Outcomes

Focal Organizing Pneumonia on Surgical Lung Biopsy* Causes, Clinicoradiologic Features, and Outcomes CHEST Focal Organizing Pneumonia on Surgical Lung Biopsy* Causes, Clinicoradiologic Features, and Outcomes Fabien Maldonado, MD; Craig E. Daniels, MD; Elizabeth A. Hoffman, MD; Eunhee S. Yi, MD; and Jay

More information

Combined Pulmonary Fibrosis and Emphysema - A Case Series

Combined Pulmonary Fibrosis and Emphysema - A Case Series IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 16, Issue 1 Ver. III (January. 2017), PP 15-19 www.iosrjournals.org Combined Pulmonary Fibrosis and Emphysema

More information

Usual Interstitial Pneumonia (UIP)

Usual Interstitial Pneumonia (UIP) , NSIP and their differential diagnoses Belfast Pathology Belfast Tuesday 20 th June 2017 Professor Andrew G Nicholson, DM, FRCPath Usual Interstitial Pneumonia () Consultant Histopathologist, Royal Brompton

More information

UNRAVELING THE ETIOLOGY OF FAMILIAL INTERSTITIAL PNEUMONIA: GENETIC INVESTIGATIONS OF A COMPLEX DISEASE. Anastasia Leigh Wise

UNRAVELING THE ETIOLOGY OF FAMILIAL INTERSTITIAL PNEUMONIA: GENETIC INVESTIGATIONS OF A COMPLEX DISEASE. Anastasia Leigh Wise UNRAVELING THE ETIOLOGY OF FAMILIAL INTERSTITIAL PNEUMONIA: GENETIC INVESTIGATIONS OF A COMPLEX DISEASE by Anastasia Leigh Wise University Program in Genetics and Genomics & Integrated Toxicology and Environmental

More information

Significance of granulomatous inflammation in usual interstitial pneumonia

Significance of granulomatous inflammation in usual interstitial pneumonia Case report SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2015; 32; 160-166 Mattioli 1885 Significance of granulomatous inflammation in usual interstitial pneumonia R. Tomic 1, H.J. Kim 1, M. Bors 1,

More information

A 72-year-old male with worsening interstitial infiltrates and respiratory failure

A 72-year-old male with worsening interstitial infiltrates and respiratory failure A 72-year-old male with worsening interstitial infiltrates and respiratory failure Case report On November 24, 2004, a 72-year-old male was admitted to the medical intensive care unit (ICU) with a history

More information

Fisiopatologia, linee guida e pratica quotidiana

Fisiopatologia, linee guida e pratica quotidiana BPCO Fisiopatologia, linee guida e pratica quotidiana Antonella Caminati U.O. di Pneumologia e UTIR Servizio di Emodinamica e Fisiopatologia Respiratoria Ospedale San Giuseppe - MultiMedica IRCCS Milano

More information

Assessment of the Lung in Primary Care

Assessment of the Lung in Primary Care Assessment of the Lung in Primary Care Andrew G Veale FRACP Auckland, New Zealand Presentation Cough (productive or dry) Haemoptysis Shortness of breath / dyspnea Wheeze (or noisy breathing) Chest pain

More information

Nitrofurantoin-Induced Lung Toxicity

Nitrofurantoin-Induced Lung Toxicity Severe Nitrofurantoin-Induced Lung Toxicity Rami Jambeih, M.D. 1, John Flesher, M.D. 1,3, Joe J. Lin, M.D. 2,4 University of Kansas School of Medicine Wichita 1 Department of Internal Medicine 2 Department

More information

EOSINOPHLIC LUNG DISEASES

EOSINOPHLIC LUNG DISEASES EOSINOPHLIC LUNG DISEASES A wide spectrum of infiltrative lung diseases characterized by infiltration of lung parenchyma with eosinophils and/or peripheral blood eosinophilia. How is the diagnosis made?

More information

Restrictive Pulmonary Diseases

Restrictive Pulmonary Diseases Restrictive Pulmonary Diseases Causes: Acute alveolo-capillary sysfunction Interstitial disease Pleural disorders Chest wall disorders Neuromuscular disease Resistance Pathophysiology Reduced compliance

More information

Key words: CT scanners; interstitial lung diseases; polymyositis-dermatomyositis; x-ray

Key words: CT scanners; interstitial lung diseases; polymyositis-dermatomyositis; x-ray Nonspecific Interstitial Pneumonia Associated With Polymyositis and Dermatomyositis* Serial High-Resolution CT Findings and Functional Correlation Hiroaki Arakawa, MD; Hidehiro Yamada, MD; Yasuyuki Kurihara,

More information

Radiological features of idiopathic interstitial pneumonia: a pictorial review

Radiological features of idiopathic interstitial pneumonia: a pictorial review Radiological features of idiopathic interstitial pneumonia: a pictorial review Poster No.: C-2012 Congress: ECR 2013 Type: Educational Exhibit Authors: M. Piccoli, F. Roccasalva, S. Palmucci, G. Cappello,

More information

Interstitial lung disease in 2015: where are we now?

Interstitial lung disease in 2015: where are we now? FOCUS Interstitial lung disease in 2015: where are we now? Lauren Troy, Tamera Corte Background Interstitial lung disease (ILD) includes a diverse group of respiratory conditions characterised by inflammation

More information

Lung CT: Part 2, The Interstitial Pneumonias Clinical, Histologic, and CT Manifestations

Lung CT: Part 2, The Interstitial Pneumonias Clinical, Histologic, and CT Manifestations Integrative Imaging Review Ferguson and Berkowitz CT of Interstitial Pneumonia Integrative Imaging Review CME SAM Lung CT FOCUS ON: Emma C. Ferguson 1 Eugene A. Berkowitz 2 Ferguson EC, Berkowitz EA Keywords:

More information

NATIONAL ASSOCIATION FOR CONTINUING EDUCATION

NATIONAL ASSOCIATION FOR CONTINUING EDUCATION Outcome Report Update on Idiopathic Pulmonary Fibrosis: State of the Art and the New Guidelines NATIONAL ASSOCIATION FOR CONTINUING EDUCATION Presented at: Cleveland Clinic Florida Weston, Florida December

More information

Diagnosis of Connective Tissue Disease Interstitial Lung Disease in 2016

Diagnosis of Connective Tissue Disease Interstitial Lung Disease in 2016 Diagnosis of Connective Tissue Disease Interstitial Lung Disease in 2016 A/Prof Tamera Corte TSANZ Annual Conference: Perth 2016 Royal Prince Alfred Hospital, Sydney, Australia Sydney Medical School, University

More information

Basic approach to PFT interpretation. Dr. Giulio Dominelli BSc, MD, FRCPC Kelowna Respiratory and Allergy Clinic

Basic approach to PFT interpretation. Dr. Giulio Dominelli BSc, MD, FRCPC Kelowna Respiratory and Allergy Clinic Basic approach to PFT interpretation Dr. Giulio Dominelli BSc, MD, FRCPC Kelowna Respiratory and Allergy Clinic Disclosures Received honorarium from Astra Zeneca for education presentations Tasked Asked

More information

USEFULNESS OF HRCT IN DIAGNOSIS AND FOLLOW UP OF PULMONARY INVOLVEMENT IN SYSTEMIC SCLEROSIS

USEFULNESS OF HRCT IN DIAGNOSIS AND FOLLOW UP OF PULMONARY INVOLVEMENT IN SYSTEMIC SCLEROSIS USEFULNESS OF HRCT IN DIAGNOSIS AND FOLLOW UP OF PULMONARY INVOLVEMENT IN SYSTEMIC SCLEROSIS Brestas P., Vergadis V., Emmanouil E., Malagari K. 2 nd Dept of Radiology, University of Athens, Greece ABSTRACT

More information

Complications of Video-Assisted Thoracoscopic Lung Biopsy in Patients with Interstitial Lung Disease

Complications of Video-Assisted Thoracoscopic Lung Biopsy in Patients with Interstitial Lung Disease Complications of Video-Assisted Thoracoscopic Lung Biopsy in Patients with Interstitial Lung Disease Mary Elizabeth Kreider, MD, MS, John Hansen-Flaschen, MD, Nadia N. Ahmad, MD, Milton D. Rossman, MD,

More information

Noninfectious Inflammatory Lung Disease: Imaging Considerations and Clues to Differential Diagnosis

Noninfectious Inflammatory Lung Disease: Imaging Considerations and Clues to Differential Diagnosis Cardiopulmonary Imaging Review Nemec et al. Noninfectious Inflammatory Lung Disease Cardiopulmonary Imaging Review Stefan Franz Nemec 1 Ronald L. Eisenberg Alexander A. Bankier Nemec SF, Eisenberg RL,

More information

Title:Pemetrexed for advanced non-small cell lung cancer patients with interstitial lung disease

Title:Pemetrexed for advanced non-small cell lung cancer patients with interstitial lung disease Author's response to reviews Title:Pemetrexed for advanced non-small cell lung cancer patients with interstitial lung disease Authors: Motoyasu Kato (mtkatou@juntendo.ac.jp) Takehito Shukuya (tshukuya@juntendo.ac.jp)

More information

Childhood Interstitial Lung Disease: Review on Diagnosis and Management

Childhood Interstitial Lung Disease: Review on Diagnosis and Management International Journal of Clinical and Experimental Medical Sciences 2016; 2(5): 78-89 http://www.sciencepublishinggroup.com/j/ijcems doi: 10.11648/j.ijcems.20160205.12 ISSN: 2469-8024 (Print); ISSN: 2469-8032

More information

Shigeki Chiba, 1 Hiromitsu Ohta, 1 Kyoko Abe, 1 Shu Hisata, 1 Shinya Ohkouchi, 1 Yasushi Hoshikawa, 2 Takashi Kondo, 2 and Masahito Ebina 1

Shigeki Chiba, 1 Hiromitsu Ohta, 1 Kyoko Abe, 1 Shu Hisata, 1 Shinya Ohkouchi, 1 Yasushi Hoshikawa, 2 Takashi Kondo, 2 and Masahito Ebina 1 Pulmonary Medicine Volume 2012, Article ID 492960, 6 pages doi:10.1155/2012/492960 Research Article The Diagnostic Value of the Interstitial Biomarkers KL-6 and SP-D for the Degree of Fibrosis in Combined

More information

CT in Idiopathic Pulmonary Fibrosis: Diagnosis and Beyond

CT in Idiopathic Pulmonary Fibrosis: Diagnosis and Beyond Cardiopulmonary Imaging Review Gruden CT of Idiopathic Pulmonary Fibrosis Cardiopulmonary Imaging Review James F. Gruden 1 Gruden JF FOCUS ON: Keywords: CT, diagnosis, high-resolution CT, idiopathic pulmonary

More information

Bronchoalveolar lavage in fibrotic idiopathic interstitial pneumonias

Bronchoalveolar lavage in fibrotic idiopathic interstitial pneumonias Respiratory Medicine (2007) 101, 655 660 Bronchoalveolar lavage in fibrotic idiopathic interstitial pneumonias Yon Ju Ryu a, Man Pyo Chung b,, Joungho Han c, Tae Sung Kim d, Kyung Soo Lee d, Eun-Mi Chun

More information

CASE REPORT PHOTOGRAPHIC NEGATIVE OF PULMONARY EDEMA. DIFFERENTIATING CHRONIC EOSINOPHILIC PNEUMONIA FROM CHRONIC HYPERSENSITIVITY PNEUMONITIS.

CASE REPORT PHOTOGRAPHIC NEGATIVE OF PULMONARY EDEMA. DIFFERENTIATING CHRONIC EOSINOPHILIC PNEUMONIA FROM CHRONIC HYPERSENSITIVITY PNEUMONITIS. CASE REPORT PHOTOGRAPHIC NEGATIVE OF PULMONARY EDEMA. DIFFERENTIATING CHRONIC EOSINOPHILIC PNEUMONIA FROM CHRONIC HYPERSENSITIVITY PNEUMONITIS. Talha Mahmud, Muhammad Omer Naeem, Muhammad Siddique ABSTRACT:

More information

Acute Exacerbation of Usual Interstitial Pneumonia After Resection of Lung Cancer

Acute Exacerbation of Usual Interstitial Pneumonia After Resection of Lung Cancer Acute Exacerbation of Usual Interstitial Pneumonia After Resection of Lung Cancer Hiroaki Sugiura, MD, Atsuya Takeda, MD, PhD, Toshiko Hoshi, MD, PhD, Yoshinori Kawabata, MD, Koichi Sayama, MD, PhD, Masahiro

More information

Hypersensitivity Pneumonitis: Spectrum of High-Resolution CT and Pathologic Findings

Hypersensitivity Pneumonitis: Spectrum of High-Resolution CT and Pathologic Findings CT of Hypersensitivity Pneumonitis Chest Imaging Pictorial Essay C. Isabela S. Silva 1 ndrew Churg 2 Nestor L. Müller 1 Silva CIS, Churg, Müller NL Keywords: high-resolution CT, hypersensitivity pneumonitis,

More information

Interstitial Lung Disease. SS Visser, Lung Unit, UP.

Interstitial Lung Disease. SS Visser, Lung Unit, UP. Interstitial Lung Disease SS Visser, Lung Unit, UP. ILD - Definition Heterogenous group of diseases with involvement of alveolar walls and peri- alveolar tissue -nonmalignant, non-infective. ± 180 diseases

More information

Interstitial Pneumonia With Autoimmune Features. Value of Histopathology

Interstitial Pneumonia With Autoimmune Features. Value of Histopathology Interstitial Pneumonia With Autoimmune Features Value of Histopathology Ayodeji Adegunsoye, MD, MS; Justin M. Oldham, MD, MS; Eleanor Valenzi, MD; Cathryn Lee, MD; Leah J. Witt, MD; Lena Chen, BS; Steven

More information

RADIOLOGICALL ANALYSIS OF INTERSTITIAL LUNG DISEASES

RADIOLOGICALL ANALYSIS OF INTERSTITIAL LUNG DISEASES Original Research Article RADIOLOGICALL ANALYSIS OF INTERSTITIAL LUNG DISEASES Meraj Rentia 1*, Himanshu Singla 1, Divya Malpani 2, Tushar Vaishnav 3, Pradeep Jhala 3 1 1 st year Resident, 2 3 rd year

More information

Interstitial Lung Disease in Infants and Children

Interstitial Lung Disease in Infants and Children Interstitial Lung Disease in Infants and Children David A. Mong, MD SUNDAY Andrew Mong MD Beyond the interstitium (path includes airways/airspace) Radiographic diffuse disease Adult Interstitial Lung Disease

More information

Lung Volume Reduction Surgery. February 2013

Lung Volume Reduction Surgery. February 2013 Lung Volume Reduction Surgery February 2013 Presentation Outline Lung Volume Reduction Surgery (LVRS) Rationale & Historical Perspective NETT Results Current LVRS Process (from referral to surgery) Diagnostic

More information

Management of Co morbidities in Idiopathic Pulmonary Fibrosis. Disclosures

Management of Co morbidities in Idiopathic Pulmonary Fibrosis. Disclosures Management of Co morbidities in Idiopathic Pulmonary Fibrosis Joyce S. Lee, MD MAS Director, Interstitial Lung Disease Clinic University of California, San Francisco Disclosures Intermune, advisory board

More information

Mayo Clin Proc, May 2003, Vol 78 BCNU-Associated Pulmonary Fibrosis 631 Figure 1. Chest radiograph of BCNU-treated patient, showing small right apical

Mayo Clin Proc, May 2003, Vol 78 BCNU-Associated Pulmonary Fibrosis 631 Figure 1. Chest radiograph of BCNU-treated patient, showing small right apical 630 Case Report Upper Lobe Pulmonary Fibrosis Associated With High-Dose Chemotherapy Containing BCNU for Bone Marrow Transplantation JAMES M. PARISH, MD; JOHN R. MUHM, MD; AND KEVIN O. LESLIE, MD Upper

More information

Subpleural Honeycombing on High Resolution Computed Tomography is Risk Factor for Fatal Pneumonitis

Subpleural Honeycombing on High Resolution Computed Tomography is Risk Factor for Fatal Pneumonitis Subpleural Honeycombing on High Resolution Computed Tomography is Risk Factor for Fatal Pneumonitis Hiroyuki Ito, MD, Haruhiko Nakayama, MD, Masahiro Tsuboi, MD, MD, Yoichi Kameda, MD, Tomoyuki Yokose,

More information

Pulmonary Aspergillosis

Pulmonary Aspergillosis May 2005 Pulmonary Aspergillosis Nancy Wei, Harvard Medical School, Year III Overview Pulmonary aspergillosis background information Patient presentations Common radiographic findings for each type of

More information

Life-long asthma and its relationship to COPD. Stephen T Holgate School of Medicine University of Southampton

Life-long asthma and its relationship to COPD. Stephen T Holgate School of Medicine University of Southampton Life-long asthma and its relationship to COPD Stephen T Holgate School of Medicine University of Southampton Definitions COPD is a preventable and treatable disease with some significant extrapulmonary

More information

Mimics in chest disease: interstitial opacities

Mimics in chest disease: interstitial opacities Insights Imaging (2013) 4:9 27 DOI 10.1007/s13244-012-0207-7 PICTORIAL REVIEW Mimics in chest disease: interstitial opacities Anastasia Oikonomou & Panos Prassopoulos Received: 19 June 2012 / Revised:

More information

Interesting Cases. Pulmonary

Interesting Cases. Pulmonary Interesting Cases Pulmonary 54M with prior history of COPD, hep B/C, and possible history of TB presented with acute on chronic dyspnea, and productive cough Hazy opacity overlying the left hemithorax

More information

Pulmonology Elective PL-1 Residents

Pulmonology Elective PL-1 Residents PL-1 Residents The Pulmonary elective is available to first year residents in either a 2 or 4 week block rotation. The experience will include performing inpatient consultations, attending outpatient clinics

More information

Imaging Cancer Treatment Complications in the Chest

Imaging Cancer Treatment Complications in the Chest Imaging Cancer Treatment Complications in the Chest Michelle S. Ginsberg, MD Objectives Imaging Cancer Treatment Complications in the Chest To understand the mechanisms of action of different classes of

More information

UC Davis UC Davis Previously Published Works

UC Davis UC Davis Previously Published Works UC Davis UC Davis Previously Published Works Title Characterisation of patients with interstitial pneumonia with autoimmune features Permalink https://escholarship.org/uc/item/0n40x0jb Journal European

More information

Treatment Guide Interstitial Lung Disease

Treatment Guide Interstitial Lung Disease Treatment Guide Interstitial Lung Disease Since interstitial lung disease (ILD) is not a single disease but a group of more than 200 different pulmonary disorders, it can be confusing to understand exactly

More information

Efficacy and safety of surgical lung biopsy for interstitial disease. Experience of 161 consecutive patients from a single institution in Italy

Efficacy and safety of surgical lung biopsy for interstitial disease. Experience of 161 consecutive patients from a single institution in Italy Original article: Clinical research SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2015; 32; 251-258 Mattioli 1885 Efficacy and safety of surgical lung biopsy for interstitial disease. Experience of

More information

pulmonary and critical care pearls

pulmonary and critical care pearls pulmonary and critical care pearls A 12-Year-Old Girl With Dyspnea and a Normal Chest Radiographic Finding* Kristin B. Highland, MD; and Patrick A. Flume, MD, FCCP (CHEST 2001; 120:1372 1376) A 12-year-old

More information

Histopathology of the idiopathic interstitial pneumonias (IIP): A review

Histopathology of the idiopathic interstitial pneumonias (IIP): A review bs_bs_banner INVITED REVIEW SERIES: IDIOPATHIC INTERSTITIAL PNEUMONIA PART 1: OVERVIEW SERIES EDITORS: TAMERA J. CORTE, ATHOL U. WELLS AND HAROLD R. COLLARD Histopathology of the idiopathic interstitial

More information

Distinct Characteristics of Pleuroparenchymal Fibroelastosis With Usual Interstitial Pneumonia Compared With Idiopathic Pulmonary Fibrosis

Distinct Characteristics of Pleuroparenchymal Fibroelastosis With Usual Interstitial Pneumonia Compared With Idiopathic Pulmonary Fibrosis [ Original Research Diffuse Lung Disease ] Distinct Characteristics of Pleuroparenchymal Fibroelastosis With Usual Interstitial Pneumonia Compared With Idiopathic Pulmonary Fibrosis Tsuneyuki Oda, MD ;

More information

Update on Pulmonary Fibrosis

Update on Pulmonary Fibrosis Update on Pulmonary Fibrosis Not All Fibrosis Is Created Equally Maxwell L. Smith, MD Context. Three distinct patterns of pulmonary fibrosis, including usual interstitial pneumonia, fibrotic nonspecific

More information

Replacement of air with fluid, inflammatory. cells or cellular debris. Parenchymal, Interstitial (Restrictive) and Vascular Diseases.

Replacement of air with fluid, inflammatory. cells or cellular debris. Parenchymal, Interstitial (Restrictive) and Vascular Diseases. Parenchymal, Interstitial (Restrictive) and Vascular Diseases Alain C. Borczuk, M.D. Dept of Pathology Replacement of air with fluid, inflammatory cells Pulmonary Edema Pneumonia Hemorrhage Diffuse alveolar

More information

Spectrum of Cystic Lung Disease and its Mimics. Kathleen Jacobs MD and Elizabeth Weihe MD UC San Diego Medical Center, Department of Radiology

Spectrum of Cystic Lung Disease and its Mimics. Kathleen Jacobs MD and Elizabeth Weihe MD UC San Diego Medical Center, Department of Radiology Spectrum of Cystic Lung Disease and its Mimics Kathleen Jacobs MD and Elizabeth Weihe MD UC San Diego Medical Center, Department of Radiology No Financial Disclosures Learning Objectives 1. Review the

More information

Are physicians in primary health care able to recognize pulmonary fibrosis?

Are physicians in primary health care able to recognize pulmonary fibrosis? EUROPEAN CLINICAL RESPIRATORY JOURNAL, 2017 VOL. 4, NO. 1, 1290339 http://dx.doi.org/10.1080/20018525.2017.1290339 Are physicians in primary health care able to recognize pulmonary fibrosis? Minna Purokivi

More information

Idiopathic pulmonary fibrosis in Saudi Arabia: Demographic, clinical, and survival data from two tertiary care hospitals

Idiopathic pulmonary fibrosis in Saudi Arabia: Demographic, clinical, and survival data from two tertiary care hospitals Original Article Idiopathic pulmonary fibrosis in Saudi Arabia: Demographic, clinical, and survival data from two tertiary care hospitals Nahid Sherbini, Maun N Feteih 1, Siraj O Wali 2, Omer S Alamoudi

More information

Effects of Interferon gamma-1b on biomarker expression in

Effects of Interferon gamma-1b on biomarker expression in Online Methods Supplement Effects of Interferon gamma-1b on biomarker expression in patients with idiopathic pulmonary fibrosis Robert M Strieter, Karen M Starko, Richard I Enelow, Imre Noth, Vincent G

More information

Pulmonary Nodules & Masses

Pulmonary Nodules & Masses Pulmonary Nodules & Masses A Diagnostic Approach Heber MacMahon The University of Chicago Department of Radiology Disclosure Information Consultant for Riverain Technology Minor equity in Hologic Royalties

More information

V CHRONIC DIFFUSE INFILTRATIVE LUNG DISEASE

V CHRONIC DIFFUSE INFILTRATIVE LUNG DISEASE V CHRONIC DIFFUSE INFILTRATIVE LUNG DISEASE Gerald W. Staton, Jr., m.d. Roland H. Ingram, Jr., m.d. Chronic diffuse infiltrative lung disease encompasses a wide variety of disorders that primarily affect

More information

[ Original Research Diffuse Lung Disease ]

[ Original Research Diffuse Lung Disease ] [ Original Research Diffuse Lung Disease ] Predicting Mortality in Systemic Sclerosis-Associated Interstitial Lung Disease Using Risk Prediction Models Derived From Idiopathic Pulmonary Fibrosis Christopher

More information

Interstitial lung diseases and, in particular, idiopathic

Interstitial lung diseases and, in particular, idiopathic Assessment of Health-Related Quality of Life in Patients With Interstitial Lung Disease* Jacqueline A. Chang, MD; J. Randall Curtis, MD, MPH; Donald L. Patrick, PhD, MSPH; and Ganesh Raghu, MD, FCCP Study

More information

Chapter 10 Respiratory System J00-J99. Presented by: Jesicca Andrews

Chapter 10 Respiratory System J00-J99. Presented by: Jesicca Andrews Chapter 10 Respiratory System J00-J99 Presented by: Jesicca Andrews 1 Respiratory System 2 Respiratory Infections A respiratory infection cannot be assumed from a laboratory report alone; physician concurrence

More information

Cystic lung diseases 7/21/2017. Cystic Lung Diseases. CT definition of a lung cyst. Important clinical clues

Cystic lung diseases 7/21/2017. Cystic Lung Diseases. CT definition of a lung cyst. Important clinical clues Cystic Lung Diseases Cystic lung diseases Aurelie Fabre Increased Awareness Spontaneous Pneumothorax High resolution imaging (HRCT) Multidisciplinary approach like interstitial lung disease CT definition

More information