When you examine the patient, they may be
clubbed. Now, this is actually unusual in patients
presenting with early fibrosis becomes
more obvious for the more severe disease.
Chest expansion will be reduced bilaterally
but it is quite hard to detect. There is no
effect in percussion note or vocal resonance.
The hallmark of pulmonary fibrosis is an
auscultation, where you will hear what we
call velcro crepitations. These are fine late
inspiratory crepitations that occur in birth.
That is the description. Normally, because
the disease is bibasal, you hear them at the
bases. In more severe disease, the patient will
be dyspnoeic at rest. They will be centrally
cyanosed and the crackles will spread from
the bases to affect the whole of the lung.
In addition, the patient might, due to chronic
hypoxia, be developing cor pulmonale and have
the signs of cor pulmonale with a raised JVP,
oedema, a right ventricular heave, etc.
Investigations of pulmonary fibrosis, we start
off with the chest X-ray which should show
reticulonodular infiltrates. Again, because
it starts off from the bases, this will be
most obvious in the bases and should be relatively
symmetrical. However, early pulmonary fibrosis
is often quite hard to see on a chest X-ray.
It is only when you got extensive diseases,
it becomes obvious as seen by this X-ray here.
Very important are lung function tests.
If you have restrictive lung function test with
reduced transfer factor, you need to think
that the patient may have pulmonary fibrosis
or another form of interstitial lung disease.
So, lung function test is incredibly important
for identifying the potential patients with
ILDs. The most important test is probably
the CT scan. I will discuss that in the next
slide or two. Blood tests are used to identify
potential causes, and that could be a rheumatoid
factor, autoantibodies, or ANCA for people with connective
tissue diseases, a serum angiotensin-converting
enzyme level to identify somebody who may
have sarcoidosis. Avian precipitins, these
are antibodies which are detectable in patients
who have hypersensitivity pneumonitis in Bird
fancier’s lung. You may want to do test
to identify differential diagnosis, and the
most important of that is probably going to
be an echocardiogram to look for people with
left ventricular impairment which might indicate
they have cardiac disease. In some patients,
which I will discuss shortly, you may want
to move on to do a bronchoscopy or a lung