• 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

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Created by Christopher Kelly
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.