• Initial ddx exertional dyspnea
  • Pulmonary (PNA, ILD)
  • CV (CHF, ischemia, constrictive pericarditis)
  • Anemia
  • Thyroid disease
  • Pregnancy
  
  

  Posted 11/15/16 09:07:21 AM by Matthew Cummings

• Asbestos-related lung disease
  • Crucial to ask extent of exposure -- was PPE worn? was asbestos being broken down? most exposure is typically safe (including if wearing appropriate PPE)
    • Asbestosis (ILD--up to 30% w/ significant asbestos exposure have abnormal HRCT)
    • Pleural disease (plaques)
    • Malignancies (SCLC and NSCLC, mesothelioma)
  
  

  Posted 11/15/16 09:11:30 AM by Matthew Cummings

• Stridor in adults
  • Anaphylaxis
  • Thyroid disease
  • Trauma (including post-op--langyeal edema/damage)
  • Malignancy/laryngeal polyps
  • Granulomas/strictures (MPA, GPA, sarcoid)
  • Epiglottitis (waning Hib immunity?)
  
  
  
  

  Posted 11/15/16 09:15:30 AM by Matthew Cummings

• Interstitial Lung Disease Overview
  • Clinically: MUST consider ILD and obtain HRCT in ANY patient w/ unexplained SOB/crackles (oftentimes r/o contribution of CHF concomitantly)
    • Known cause/association
      • Systemic disease
        • Vasculitis (MPA, GPA, Churg-Strauss, etc -- ANCAs/MPO/PR3)
        • Connective tissue disease (RA, SS, Sjogrens, Dermato/polymyositis--good H&P--skin, joints, muscle, hands, serologies--can  oftentimes see ILD w/ +serologies PRIOR to joint/muscle involvement)
        • Sarcoidosis
      • Exposures: 
        • Medication/drug-related (Amiodarone, MTX, Other chemo)
        • Chest radiation
        • Occupational (pneumoconiosis--silica, asbestos)
        • Environmental (HP--insp. squeak, mosaic attenuation on CT, +granulomas on bx)
        • Smoking-related (IPF, idiopathic DIP, idiopathic RB-ILD, PLCH)
      • Genetic (Hermansky-Pudlak)
    • Unknown cause
      • Idiopathic interstitial PNAs
        • IPF, NSIP
        • COP/BOOP
      • Specific pathology
        • LAM
        • PAP
  
  

  Posted 11/15/16 09:30:31 AM by Matthew Cummings

• RA-associated ILD
  • Never forget atlanto-axial subluxation risk -- cervical Xrays PRIOR to OR/intubation
  • Often related to chronic inflammation, immunosuppression or direct toxicity from DMARDs/biologics.
    • Parenchymal disease (ILD) 
    • Pleural disease (pleural thickening and effusions)
    • Airway and PVD (vasculitis, laryngeal polyp, and pulmonary hypertension)
  • Emerging association between +RF titers and subclinical ILD (even in absence of joint involvement)
    
    
  
  

  Posted 11/15/16 09:40:27 AM by Matthew Cummings

• For further reading...

  ATS/ERS International Multidisciplinary Classification of IIPs
  ERJ Review -- RA-associated lung disease
  
  
  
  

  Posted 11/15/16 09:45:33 AM by Matthew Cummings

---

Created by Christopher Kelly

Know a hypochondriac? Get them the best-selling book 'AM I DYING?!: A Complete Guide to Your Symptoms, and What to Do Next'
The information on the website does not constitute official guidelines except where explicitly stated.
It is not meant to replace the advice of a health professional.