*Are characterised by varying patterns of inflammation & fibrosis in the lung parenchyma. Also it’s autoimmun dis *the etiology remains unkown: 1- infection (EPV) 2- occupational dusts 3- antidepressants drugs 4- GERD 5- genetic 6- cigarette smoking
@clinical features: *elderly , after age of 50, *insidous SOB & dry cough. *clubbing in 25-50% *late inspirotery crackles at lung bases, later on central cyanosis& RV failure.
Diagnosis: Major criteria: 1- exclusion of other causes of pulm fibrosis (drugs etc….) 2- restrictive lung pattern 3- bibasillar reticular abnormalities with minimal ground glass apperance on CT scan. 4-BAL not show other alternative Dx. Minor criteria: 1- age > 50 years. 2- insidous onset of unexplained SOB 3- duration of illness > 3 months 4- bibasillar inpsiretory crackles.
@investigations: *Rh factor & ANA detected in 30-50%. *ESR & LDH is elevated. *PFT: restrective pattern with reduce lung volumes & gas transfer *hypoxia. *CXR: reticulonodular opacities *HRCT. *lung biopsy.
@managment: *predinsolone 0.5mg/kg combined with azathioprine2-3mg/kg in: highly symptomatic, groung glass appearance on CT, < more than 15% decrease in VC over 3-6 months.
*Antiviral cytokines Interferon gamma and interferon beta have been demonstrated to inhibit proliferation of fibroblasts and suppress the production of connective-tissue matrix protein in both animals and humans. * antifibrotic agent pirfenidone. * anti – oxidants: N acetyl cystein *Maintaining adequate nutritional intake and immunizations (ie, pneumonia vaccine, influenza vaccine) *O2: improve excersise tolerance. *diuretics for cor-pulmonale *lung transplantation Complications Adverse drug effects (closely monitor) Cor pulmonale Pneumothorax Infection Carcinoma Thromboembolic diseases
Prognosis The following factors are associated with worse prognosis: Older age Male sex Cigarette smoking Higher predominance of honeycombing on the lung HRCT scan Lower diffusing capacity on pulmonary function test results at the time of diagnosis Higher rate of acute exacerbations of IPF Presence of pulmonary hypertension
Hypersensetivity pneumonitis: *are result from inhalation of organic dust which give rise to diffuse immune complex reaction: =Farmer’s lung-mouldy hay grain. =Bird’s fancier’s lung-avian exreta, feathers. =Malt worker’s lung-mouldy maltings. =cheese worker’s lung-mouldy cheese. *clinically present as influenza-like illness with wide spread end-inspiretory crackles *So to diagnose HP : 1- exposure to a known antigen. 2- +ve ab to antigen. 3- recurrent episodes of symptoms 4- inspiretory crackles 5- wt loss.
@Treatmen:
@Coal worker’s Pneumoconiosis: *simple: asymptomatic, not progress after sessation of exposure *complicated: symptomatic , usually black sputum & SOB. @Silicosis: *inhalation of silica. *3-5 mm nodular opacities in the mid & upper zones & egg shell calcification oF hilar LN , *great risk of TB. @Asbestosis: *occupational lung diseases(ship breaking, demoltion) *risk of CA lung, larynx, mesotheloima, pleural effusion. *the disease develop after 20 years. (ILD).
@PLEURAL EFFUSION: *Is the accumulation of fliud within the pleural space. Normally the small volume of pleural fluid, which has been calculated at 0.13 mL/kg of body weight under normal circumstances, serves as a lubricant to facilitate movement of the pleural surfaces against each other in the course of respirations *2 types transudative & exudative *causes: *bilateral pleural effusion: *empyma: *hemothorax: *chylous:
Normal pleural fluid has the following characteristics: 1-Clear ultrafiltrate of plasma that originates from the parietal pleura 2-pH 7.60-7.64 3-Protein content less than 2% (1-2 g/dL) 4-Fewer than 1000 WBCs per cubic millimeter 5-Glucose content similar to that of plasma 6-Lactate dehydrogenase (LDH) less than 50% of plasma 7-Sodium, potassium, and calcium concentration similar to that of the interstitial fluid *diagnosis: 1- examination: 350-500 ml 2- CXR: 200 ml(PA) & 150 ml(Lateral). 3- U/S: 5-50 ml 4- CT scan: 5- aspiration
1- biochemical: (protien, albumin, glucose, cholesterol, TG) 2- cytology(WBC & differential, malignant cells, AFB). 3- ph OF aspirated fliud which decrease in empyma, malig, TB. 4- ADA. 5- culture. Light’s criteria: the pleural fluid is exudate if have one or more of the: ()pleural fluid protien: serum protein ratio > 0,5 ()pleural fluid LDH: serum LDH ratio> 0.6 ()pleural fluid LDH > 2/3 OF upper limit of S LDH. SEAG: serum albumin _ pleural fluid albumin <1.2 g/dl === exudative >1.2 g/dl=== transudative