Diffuse Parenchymal Lung Disease

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Diffuse Parenchymal Lung Disease

• bilateral, diffuse

• Interstitial lung disease

Common Causes of Lung Fibrosis

Widespread

• Fibrosing Alveolitis

  • cryptogenic

  • connective tissue disease

  • occupational exposure

    • silicosis

    • asbestosis

    • hay

• drugs

  • amiodarone

  • chemotherapeutic

    • busulphan

  • nitrofurantoin

• extrinsinc allergic alveolitis

• Lymphangitis carcinomatosis

Upper

• TB

• radiation 

  • Breast Cancer

• Ankylosing Spondylitis

Lower

• rheumatoid diseases

  • scleroderma

• sarcoidosis

• organic and inorganic dust

• asbestosis

• sillicosis

• Pulmonary oedema

• Mitral Stenosis

• Infection

  • Pneumocystis carinii

  • viral pneumonia

NOT CAUSED BY

• pneumonia

• emphysema

• cystic fibrosis

History

• shortness of breath

  • developing over months / years

• Drug history

• Occupation

Examination

• Clubbing

  • fibrosing alveolitilis

  • asbestosis

• Fine crepitations

  • late inspiratory (velcro crackles)

Investigation

• CXR

  • fibrosis

  • small lung volume

  • reticulonodular pattern

    • especially in middle and lower lobe

• Pulmonary function tests

  • restrictive patterns

  • small flow-value

• CT -high resolution

  • alveolar process

• Bronchoscopy +/- biopsy

  • sarcoid

• Surgical biopsy

Treatment

• steroids 1mg/kg - 3 months

• azathioprine

• cyclophosphamide

• Transplant

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