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Acute Interstitial Lung Disease


Presentation

  • In the present cases, we indicate that serum ferritin level correlated with activity of A/SIP with DM. Two patients, a 65-year-old woman and a 30-year-old woman, were diagnosed with anti-MDA5 antibody-associated A/SIP with DM.[ncbi.nlm.nih.gov]
  • Mild honeycombing, usually affecting 10% of the lung, may be present. Routine laboratory tests are nonspecific and generally not helpful.[merckmanuals.com]
  • CASE PRESENTATION A 47-year-old Indian woman, who was a non-smoker, presented with severe upper interscapular back pain since 1 month. Radiological evaluation revealed a right upper lobe lung mass with T5 and T9 vertebral body metastasis.[omcr.oxfordjournals.org]
  • Antibiotic therapy for all patients presenting with SIRS criteria (temperature 38.0 C or 90 bpm, respiratory rate 20 or PCO2 32 Torr).[emdocs.net]
  • In conclusion, our findings suggest that crizotinib induced ILD may have two distinct clinical presentation.[oatext.com]
Cough
  • Symptoms of acute interstitial pneumonia consist of the abrupt onset of fever, cough, and shortness of breath, which in most patients increase in severity over 7 to 14 days, progressing to respiratory failure.[merckmanuals.com]
  • Hospital) and Brit Long, MD (@long_brit, EM Attending Physician at SAUSHEC) A 55 year-old female with a history of idiopathic pulmonary fibrosis and pulmonary hypertension (prednisone, sildenafil, and bosentan therapy) presents with a three day history of cough[emdocs.net]
  • Cryptogenic Organizing Pneumonia (COP) Patients with COP typically present with a subacute illness of relatively short duration with cough and dyspnea ( 56, 57 ).[shortnessofbreath.it]
  • Acute interstitial pneumonitis typically progresses rapidly, with hospitalization and mechanical ventilation often required only days to weeks after initial symptoms of cough, fever, and difficulties breathing develop.[en.wikipedia.org]
  • The main symptoms are exertional dyspnea and a dry cough. Bibasilar inspiratory crackles or rales are usually heard on auscultation. Treatment is based on the underlying cause.[amboss.com]
Dyspnea
  • On the 215th day after initiation of alectinib administration, she was admitted to our hospital with the symptom of progressive dyspnea.[ncbi.nlm.nih.gov]
  • Yamaguchi et al. presented an autopsy case involving a patient with advanced HCC who developed rapidly progressive dyspnea on the 19 th day of sorafenib and lost on the 3 rd day of admission [6].[oatext.com]
  • A dyspnea began in a precise moment, associated to pleural/thoracic pain, tachycardia, and an history of previous DVT can be associated to pulmonary embolism (PE).[shortnessofbreath.it]
  • The main symptoms are exertional dyspnea and a dry cough. Bibasilar inspiratory crackles or rales are usually heard on auscultation. Treatment is based on the underlying cause.[amboss.com]
  • For example, exertional dyspnea in ILD resembles dyspnea experienced by patients with more common ailments such as asthma, COPD, and heart disease.[consultant360.com]
Dry Cough
  • CONCLUSION The diagnosis of ILD should be made after no more than 3 weeks during the evaluation of chronic exertional dyspnea and dry cough.[consultant360.com]
  • The main symptoms are exertional dyspnea and a dry cough. Bibasilar inspiratory crackles or rales are usually heard on auscultation. Treatment is based on the underlying cause.[amboss.com]
  • Many interstitial lung disease sufferers also experience a dry cough. Weight loss can also be a common symptom of interstitial lung disease, especially in patients who have pneumonia.[callung.com]
  • A person may have these symptoms: A dry cough Shortness of breath, which may occur after effort or become worse over time Difficult or labored breathing Fatigue Clubbing, or enlargement of the fingertips at the base of the nails.[my.clevelandclinic.org]
  • cough, chest pain with exertion, and even syncope (described in the setting of an ILD resulting in pulmonary hypertension and subsequent right heart failure). 3,6 In this patient population, emergency department (ED) evaluation begins as all others:[emdocs.net]
Exertional Dyspnea
  • The main symptoms are exertional dyspnea and a dry cough. Bibasilar inspiratory crackles or rales are usually heard on auscultation. Treatment is based on the underlying cause.[amboss.com]
  • TREATMENT Refrain from empiric drug treatment(s) until the cause of exertional dyspnea and dry cough is sufficiently clear and other more common causes of exertional dyspnea are eliminated, such as COPD and heart failure.[consultant360.com]
  • Severe exertional dyspnea develops over a matter of days to weeks 13 . AIP is characterized histologically by diffuse alveolar damage (DAD) 2 .[radiopaedia.org]
Dyspnea at Rest
  • […] at rest Persistent nonproductive cough Fatigue Other symptoms related to underlying primary disorder (eg, joint pain in connective tissue disorder ) Later stages of disease: digital clubbing due to chronic hypoxia IPF : The majority of patients ( 70%[amboss.com]
  • Late: dyspnea at rest, weight loss; clubbing, cyanosis, and right ventricular failure. Chest Roentgenography Early: normal to ground-glass pattern and nodular, reticular or reticulonodular patterns.[lumen.luc.edu]
Cutaneous Manifestation
  • Specific systemic involvement such as rheumatoid nodules, cutaneous manifestations (e.g. finger cutaneous thickening, puffy hands, mechanic hands) or osteo-articular deformities (e.g. ulnar deviation, boutonniere deformity, swan neck deformity) can lead[shortnessofbreath.it]

Workup

  • […] can also be found in other diseases such as CTDs, which is another ILD classification, but is idiopathic when the cause is unknown despite a comprehensive workup.[consultant360.com]
  • […] often needed to make a diagnosis, with pertinent information and expertise contributed by the pulmonologist, radiologist and pathologist. 4 High-resolution CT should be obtained in virtually all patients with a suspected ILD. 4 Additional diagnostic workup[appliedradiology.com]
  • BAL cell count and differential may be useful in the diagnostic workup of the hospitalized patient with ILD.[bmcmedicine.biomedcentral.com]
Pulmonary Infiltrate
  • infiltrates, PaO 2 /FiO 2 300, and PAWP 18) in the absence of heart failure, pulmonary infection, pulmonary embolism (PE), aspiration, or drug reaction. 4,10-13 Acute exacerbations have been documented in patients with the subgroup classifications of[emdocs.net]
  • Radiology A chest x-ray is performed at first instance, showing bilateral pulmonary infiltrates. This aspect is not specific for any etiology; however, it can be useful to rule out pneumothorax.[shortnessofbreath.it]
  • Eosinophilic Pneumonia Pulmonary infiltrates and blood/tissue eosinophilia may occur in several distinct diseases: Loffler's syndrome, acute tropical pneumonia, chronic eosinophilic pneumonia, drug-induced eosinophilic pneumonia, Churg-Strauss syndrome[lumen.luc.edu]
  • Usefulness of open lung biopsy in mechanically ventilated patients with undiagnosed diffuse pulmonary infiltrates: influence of comorbidities and organ dysfunction. Crit Care. 2007;11:R93.[bmcmedicine.biomedcentral.com]
Kerley A Lines
  • Lymphangitic Carcinomatosis Progressive dyspnea; CXR showing Kerley B lines, restrictive defect on PFTs; biopsy showing malignant cells.[lumen.luc.edu]
Pneumothorax on Chest X-Ray
  • This aspect is not specific for any etiology; however, it can be useful to rule out pneumothorax. After chest x-ray, a chest HRCT is performed, combined with angio-CT if the suspicion of PE hasn’t been ruled out.[shortnessofbreath.it]

Treatment

  • This makes high dose steroid as an attractive treatment option.[oatext.com]
  • Intensity of treatment may be decided according to serum ferritin level.[ncbi.nlm.nih.gov]
  • These cases generally occurred within 2 months after the initiation of treatment [ 6 ].[omcr.oxfordjournals.org]
  • Medical treatment of AE-IPF other than high-dose intravenous corticosteroids mono therapy.[frontiersin.org]

Prognosis

  • We assessed the correlation between the serum PGRN levels and the activity indexes of ILD or prognosis in DM patients with ILD.[ncbi.nlm.nih.gov]
  • Prognosis The prognosis of acute respiratory failure in patients with ILD in general, and IPF specifically, is poor, especially for those who require ICU admission and/or mechanical ventilation.[clinicaladvisor.com]
  • Prognosis good but depends on the extent of fibrosis at diagnosis greater than 10 years. But Surgical Biopsy is needed to confirm.[slideshare.net]
  • Even despite mechanical ventilation, it often carries a grave prognosis with 70% mortality at 3 months 1 .[radiopaedia.org]
  • Exudative phase on CT Organizing phase on CT Comparison on CT and histology Prognostic factors Most patients die within 2 months unless appropriate treatment is provided ( Eur Respir J 2000;15:412 ) High dose steroid therapy drastically improves the prognosis[pathologyoutlines.com]

Etiology

  • There is a wide variety of well-known etiologies, including infection/sepsis, shock, trauma, aspiration, oxygen toxicity and many others.[eprints.bice.rm.cnr.it]
  • If the aforementioned evaluation identifies an ALI without etiology presume ILD exacerbation, initiate broad-spectrum antibiotics, consult pulmonology, and admit to the ICU.[emdocs.net]
  • The first is supportive; the second is aimed at treating identifiable underlying etiologies.[clinicaladvisor.com]
  • […] specific etiologic agent or inciting event.[emedicine.medscape.com]
  • Immune modulators and corticosteroids are used in cases of unknown etiology. In advanced stages of disease ILD can result in pulmonary insufficiency and respiratory heart failure with right ventricular insufficiency.[amboss.com]

Epidemiology

  • The epidemiology of interstitial lung diseases. Am J Respir Crit Care Med. 1994; 150:967-972. Coultas D, Hughes M. Accuracy of mortality dat for interstitial lung diseases in New Mexico, USA. Thorax. 1996; 51:717-720.[emdocs.net]
  • Epidemiology [ edit ] Acute interstitial pneumonitis occurs most frequently among people older than forty years old. It affects men and women equally. There are no known risk factors; in particular, smoking is not associated with increased risk.[en.wikipedia.org]
  • Extremely rare (no conclusive epidemiological data available) Mean age 50 years but can occur at any age (7 - 83 years) ( Eur Respir J 2000;15:412 ) No sex predilection Sites Bilateral lung, usually in all five lobes of the lung Pathophysiology Both[pathologyoutlines.com]
  • Epidemiology It is common, if all causes of pneumonitis are considered.[patient.info]
  • Raghu G, Nyberg F, Morgan G (2004) The epidemiology of interstitial lung disease and its association with lung cancer. Br J Cancer 91: (Suppl 2)S3–S10. View Article Google Scholar 6.[journals.plos.org]
Sex distribution
Age distribution

Pathophysiology

  • However, pathophysiological mechanism and predictive patient and tumor related risk factors for crizotinib-induced ILD are not well understood.[oatext.com]
  • Introduction Definition restricted lung expansion results in reduced lung volumes (TLC and FVC) Pathophysiology poor breathing mechanics with normal lung function muscle weakness polio and myasthenia gravis chest wall limitation kyphosis, scoliosis, and[medbullets.com]
  • Eosinophilic pneumonia Eosinophilic pneumonia is similar to organizing pneumonia in pathophysiology, but is mediated instead by an inappropriate increase in the number of eosinophils and macrophages in alveoli.[appliedradiology.com]
  • […] damage Epidemiology Extremely rare (no conclusive epidemiological data available) Mean age 50 years but can occur at any age (7 - 83 years) ( Eur Respir J 2000;15:412 ) No sex predilection Sites Bilateral lung, usually in all five lobes of the lung Pathophysiology[pathologyoutlines.com]
  • Pathophysiology NA Epidemiology The overall incidence of acute respiratory failure in patients with ILD has not been well established. Infection and acute exacerbations of underlying ILD appear to be the most common precipitating etiologies.[clinicaladvisor.com]

Prevention

  • Prompt discontinuation of the offending drug and initiation of corticosteroid therapy may prevent adverse outcomes.[omcr.oxfordjournals.org]
  • Is there a way to prevent chILD? There’s no way to prevent chILD but you can take steps to avoid diseases that may make it worse. Frequent hand-washing and keeping your child away from pollutants like cigarette smoke can improve her quality of life.[childrens.com]
  • Can interstitial lung disease be prevented? Interstitial lung disease can be prevented only to the extent that its individual causes may be prevented.[medicinenet.com]
  • Interestingly, there is data that the perioperative use of pirfenidone might prevent postoperative AE-IPF ( 121 ).[frontiersin.org]
  • The goal of treatment for people with ILD is to prevent more scarring and manage symptoms.[choc.org]

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