Pearls from Dr. Nina Patel

Hypersensitivity pneumonitis in a young woman with subacute cough and weight loss


  • Young woman w/ subacute SOB = broad differential

    Posted 05/29/16 03:56:52 PM by Matthew Cummings

  • Hypersensitivity pneumonitis (HP): ILD caused by ongoing inhalation of antigen to which individual has been sensitized

    Posted 05/29/16 03:57:11 PM by Matthew Cummings

  • HP clinically presents with repeated episodes of fever/cough/SOB or progressive SOB if fibrotic disease

    Posted 05/29/16 03:57:41 PM by Matthew Cummings

  • High-resolution CT chest in HP: findings variable, range from GGO, centrilobular nodules w/ mosaic attenuation --> fibrosis in chronic HP

    Posted 05/29/16 03:59:39 PM by Matthew Cummings

  • Bronchoscopy in HP: BAL classically w/ lymphocytosis, abnormal CD4/CD8 ratio --> bx with noncaseating granulomas

    Posted 05/29/16 04:00:13 PM by Matthew Cummings

  • Differential diagnosis for HP: 

    Posted 05/29/16 04:00:56 PM by Matthew Cummings

  • HP treatment: often good prognosis if treated early

    Posted 05/29/16 04:02:11 PM by Matthew Cummings

  • For further reading...

    Clinical diagnosis of hypersensitivity pneumonitis
    Hypersensitivity pneumonitis: diagnosis and pathogenesis
    Update in hypersensitivity pneumonitis (Chest 2012)

    Posted 05/29/16 04:06:50 PM by Matthew Cummings

  • 62 yo woman with 8 months of worsening SOB found to have NSIP secondary to as yet diagnosed connective tissue disease


  • Four items on initial evaluation of patient that indicate new diagnosis of ILD

    Posted 12/13/16 10:46:33 AM by Anna Krigel

  • Sarcoidosis - nodular pattern in parenchyma on imaging as opposed to linear pattern

    Posted 12/13/16 10:47:00 AM by Anna Krigel

  • Restrictive Lung Disease

    Posted 12/13/16 10:48:11 AM by Anna Krigel

  • Four categories of Interstitial Lung Disease

    Posted 12/13/16 10:53:19 AM by Anna Krigel

  • Idiopathic Interstitial Pneumonias

    Posted 12/13/16 11:54:15 AM by Anna Krigel

  • 29yo F with recurrent otitis media p/w b/l ear pain, cough, fevers, and rigors


  • Recurrent sinus infections in a young patient: think hereditary disorders (primary ciliary dyskinesia, cystic fibrosis, immune deficiencies) in patients with relevant family history

    Sarcoidosis on CT

    See cavitary nodules concerning for Actinomyces infection?

    See cavitary nodules concerning for tuberculosis?

    Cavitary nodules are most common manifestation of pulmonary disease on chest imaging!

    Posted 05/30/17 11:59:23 AM by Iheanacho (Obi) Emeruwa

  • 21yo F with rapid onset SOB, found to have hypersensitivity pneumoniitis


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