uppträder perifiert men lite här och var
UIP
Interstitiet ær normalt osynligt. Synligt vid till exempel ödem, fibros, tumor.
Vid både interstitiell och alveolært mönster -viktigt att avgöra dominerande mönster.
Broncovaskulær/ Acinar / Subpleural
Linjær(Kerley) /retikulær/nodulær/reticulonodulær/retikulær-honeycomb
Linjær mønster vid: Ødem, Lymfangitis carcinomatosa, Idiopatisk pulmonær fibros, Viral/mycoplasma pneumoni, Sarcoidos.
Nodulær mønster: 1-2 mm(milliær) - 1 cm. Vid: "SHRIMP" Sarcoidosis(øvre), Hystiocytosis(langerhans cell, øvre), Reumatiod nuduli, Infektion(pneumoconios(lower), TB(øvre), Svamp(øvre) ), Metastas, Microlithiasis,
Sarcoid
Langerhans Granulomatosis
Idiopathic pulmonary fibrosis
Lymfagitic tumor
Edema
Asbestosis
Collagen vascular diseases
Silicosis
Farmers lung
(Mycobac avium complex)
Noncaseating granuloma
bilateral lymfadenopathy
as LGLL regress paradox. lung changes progress
uncommon alveolar sarcoidosis : Alveolar airspace masses often upper lobes.
HRCT - groung glass + centriacinar nodules+ septa + bronchiole + blood vessels (following lymphatics)= lymfatic nodule
advanced disease - less common. fibrosis cutting from mediastinum to periphery
Allergic reaction to something in cigarette smoke
25% present w pnthx
2/3 resolve
Disease in upper and middle lung
increased lung volume
nodules and cysts
HRCT - centriacinar nodules - sparing the subpleural space = respiratory nodule
larger nodules may look like starfish
nodules cavitate and aggregate forming bizzare cavities
Repetitive insult to alveolar wall
Median survival after diagnosis 5 yrs
collagen deposition and fibrosis
reticular- honeycombing pattern
decreased lung volume
restrictive pulm funtion tests
lower parts of lungs
traction bronchiectasis
ground glass opacities -non specific (fibrosis/atelectasis)
Hematogenic/direct lymphatic spread
Adenocarcinomas: lung breast GI
Usually spares some part of lungs
may have effusion/lgll
axial/periferal(septal) nodules
irregular septal thickening is typical
Ground glass opacities - mosaic perfusion(sparing some lobules)
Septal thickening(smooth)
Gravitational gradient
Enlarged heart & batwing
(diff other asbest diseases: pleural plaque, diffuse pl thickening, mesothelioma)
Asbestos body=asbest+macrofag
A pneumoconiosis
20-30 yr latent
multiplicative risk w smoking
perifery lower lungs
honeycombing (end stage)
irregular reticular opacities
HRCT centriacinar nodules
short lines to perifery or larger bands in advanced disease
NSIP/UIP patterns are indistinguishable from IPF
basal periferal honey combing
decreased lung volumes
dyspnea is common
Generalized connective tissue disease (ex scleroderma)
NSIP has longer life expectancy
NSIP -cellular and fibrotic in all biopsy sites
UIP - different combinations of cellular/fibrotic patterns
Inorganic - organic
silica, coal
farmers lung
path response varies depending on particular dust
silicosis(inorganic)- upper lung nodular pattern in axial and periferal distribution - lgll egg shell calcification
HRCT - in some a dorsal distribution, even nodules may calcify
farmer's lung(actinomyces reaction) - 90% normal chest x-ray: midlung distribution, spares costphrenic angle, miliary nodules (jf IPF som ger sig på cf-angle)
HRCT 50% normal, centriacinar nodules, air trapping areas
Drugs:
Many responses possible.
Macrodantin - UIP pattern, add to diff for any diffuse lung disease