Interstitial lung disease: Difference between revisions
(Created page with "<section begin="radiology" />'''Interstitial lung disease''' (ILD), also called '''diffuse parenchymal lung disease''', is a group of disorders characterised by fibrosis of the lungs. There are many different types. The name implies that these disorders only affect the interstitium of the lung and not the parenchyma (the airways and alveoli), but many of these disorders affect the parenchyma as well. It's more common in males, but ILD is rare overall. == Etiology == Th...") |
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Pulmonary function testing is obligatory. | Pulmonary function testing is obligatory. | ||
ILD has characteristic imaging findings. Radiography usually shows a reticular pattern, a nodular pattern, or a mix of the two. However, high-resolution CT is obligatory in the evaluation. Some types of ILD have characteristic CT findings, but most types show any of the following patterns: | ILD has characteristic imaging findings. Radiography usually shows a reticular pattern, a nodular pattern, or a mix of the two. However, high-resolution CT is obligatory in the evaluation. Some types of ILD have characteristic CT findings, but most types show any combination of the following patterns: | ||
* Ground glass opacities | * Ground glass opacities | ||
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* Reticular opacities | * Reticular opacities | ||
* Nodules | * Nodules | ||
Idiopathic pulmonary fibrosis has a characteristic sign called ''honeycombing'', named after the honeycomb-like appearance the lung takes on due to formation of clustered cystic air spaces. | |||
Silicosis causes "eggshell calcification", which is well-defined sickle-shaped calcification of the rims of the hilar lymph nodes. Bilateral diffuse ground glass opacities and uniformly distributed small nodules are also typical. | |||
Bronchoalveolar lavage and lung biopsy may be indicated if the type remains uncertain.<section end="radiology" /> | Bronchoalveolar lavage and lung biopsy may be indicated if the type remains uncertain.<section end="radiology" /> | ||
Latest revision as of 20:50, 27 November 2023
Interstitial lung disease (ILD), also called diffuse parenchymal lung disease, is a group of disorders characterised by fibrosis of the lungs. There are many different types. The name implies that these disorders only affect the interstitium of the lung and not the parenchyma (the airways and alveoli), but many of these disorders affect the parenchyma as well.
It's more common in males, but ILD is rare overall.
Etiology
The list of causes of ILD is basically endless, but here are some of the most typical:
- Idiopathic
- Idiopathic pulmonary fibrosis
- Idiopathic interstitial pneumonia
- Environmental and occupational exposure
- Silica crystals (causes "silicosis")
- Asbestos (causes "asbestosis")
- Coal dust (causes "coal worker pneumoconiosis")
- Mineral dust
- Organic dust
- Drugs
- 350+ drugs can cause ILD
- Auto-immune and rheumatological diseases
- Infiltrative disorders
Most cases of ILD are idiopathic. The most common identifiable causes include exposure- and drug-induced ILD.
Clinical features
Interstitial lung disease causes gradual onset dyspnoea and sometimes cough.
Many ILDs are complicated by pulmonary hypertension, which may be symptomatic.
Diagnosis and evaluation
Pulmonary function testing is obligatory.
ILD has characteristic imaging findings. Radiography usually shows a reticular pattern, a nodular pattern, or a mix of the two. However, high-resolution CT is obligatory in the evaluation. Some types of ILD have characteristic CT findings, but most types show any combination of the following patterns:
- Ground glass opacities
- Lung consolidation
- Reticular opacities
- Nodules
Idiopathic pulmonary fibrosis has a characteristic sign called honeycombing, named after the honeycomb-like appearance the lung takes on due to formation of clustered cystic air spaces.
Silicosis causes "eggshell calcification", which is well-defined sickle-shaped calcification of the rims of the hilar lymph nodes. Bilateral diffuse ground glass opacities and uniformly distributed small nodules are also typical.
Bronchoalveolar lavage and lung biopsy may be indicated if the type remains uncertain.
Management
In all cases, lifestyle changes which are lung protective are indicated. These include smoking cessation and avoidance of exposures. A corticosteroid or other immunosuppressants may be useful.
In case of ILD secondary to an underlying disorder, it should be treated.