ILD: Interstitial Lung Disease

by Jeremy Brown, PhD

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    The subject of this lecture are interstitial lung diseases. These are non-infective, non-malignant infiltrations of the lung parenchyma. That is, they are diseases where the alveoli and the interstitium, the gap between the alveoli and the pulmonary capillaries and the rest of the lung is infiltrated by non-infective and non-malignant cellular content and extracellular components. There are a range of diseases which are in this category. The most important of which is lung fibrosis and sarcoidosis. In addition, there are diseases which are responses to inhaled substances and antigens such as hypersensitivity pneumonitis and pneumoconiosis, and a large range of unusual and very rare interstitial and infiltrative lung diseases which are normally included in the ILD category. In general, ILDs, interstitial lung diseases, cause a restrictive lung function pattern. That is they reduce the FEV1 and the FVC. As you can see on this diagram on the right hand side here that the ratio between the FEV1 and FVC is often increased and in fact, total lung capacity is reduced as well. In general, CT scans are also essential for an accurate assessment of these types of diseases. Pulmonary fibrosis is often a progressive disease and is actually very difficult to treat. Categorizing ILDs is not straightforward. This is one way of doing of categorizing ILDs and is a useful way of thinking about them in general. So for example, here we have five categories. On the right hand side, you have pulmonary fibrosis. That has several different causes. It could be idiopathic, which is the commonest cause. It means that we don’t know what’s causing it. Or it can be associated with connective tissue disease such as rheumatoid arthritis or dermatomyositis. In addition, there are ranges of other situations where pulmonary fibrosis develops such as radiotherapy, drug-associated, by various...

    About the Lecture

    The lecture ILD: Interstitial Lung Disease by Jeremy Brown, PhD is from the course Interstitial Lung Disease (ILD). It contains the following chapters:

    • Interstitial lung diseases
    • Pathology of ILD
    • Pulmonary fibrosis
    • Signs and investigation
    • Clinical recognition and CT scans
    • Invasive tests and treatment
    • Hypersensitivity pneumonitis
    • Pneumoconiosis
    • Sarcoidosis
    • Manifestations of extrapulmonary sarcoid
    • Sarcoidosis - histological confirmation

    Included Quiz Questions

    1. Interstitial lung disease are characterised by non-infecive infiltrations of the interstitium and alveoli.
    2. Interstitial lung disease usually do not affect the transfer factor.
    3. Interstitial lung disease can usually be diagnosed accurately using a chest X ray.
    4. Interstitial lung diseases usually cause obstructive defects in spirometry.
    1. Progressive dyspnoea in a 25 year old woman and idiopathic pulmonary fibrosis
    2. Systemic sclerosis and pulmonary fibrosis
    3. Extensive asbestos exposure and basal inspiratory crepitations
    4. Chemotherapy and progressive dyspnoea
    1. Raised residual volume and total lung capacity
    2. A reduced transfer factor
    3. Restrictive changes on spirometry
    4. Reduced residual volume and total lung capacity
    1. A past history of rheumatoid arthritis
    2. Upper lobe rather than lower lobe disease
    3. A positive avian precipitins blood test result
    4. Centrilobular nodules on the CT thorax
    1. A unilateral hilar mass
    2. Bilateral symmetrical hilar lymphadenopathy
    3. Bilateral upper lobe infiltrates
    4. A normal chest X ray
    1. Progressive right sided constant chest pain
    2. Abnormal chest X ray but no chest symptoms
    3. Heart block on the ECG
    4. Non-tender purple lumps in the skin
    1. Presence of non-caseating granulomas in an endobronchial ultrasound guided biopsy of an enlarged mediastinal lymph node
    2. A raised serum angiotensin converting enzyme level
    3. Mixed restrictive / obstructive lung function changes
    4. Upper lobe changes on the chest X ray

    Author of lecture ILD: Interstitial Lung Disease

     Jeremy Brown, PhD

    Jeremy Brown, PhD

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    Fantastic. Hungry for more detail
    By Hamed S. on 02. March 2017 for ILD: Interstitial Lung Disease

    Hi Lecturio team great talk on ILD. But it would have been good to discuss the pneumoconiosis in some more detail. Particularly how to best differentiate one from another a side from hx. chest -xray of silicosis showing an egg appearance. How severity of asbestosis depends on the nature of the fibers eg sereptine can have a less severe pathogenesis.