Difference between revisions of "Diffuse lung diseases"

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'''Diffuse lung diseases''', abbreviated '''DLD''', are a group of uncommon pathologies, also known as '''idiopathic interstitial pneumonias''', abbreviated '''IIPs'''. They are a subgroup of the [[medical lung diseases]].   
'''Diffuse lung diseases''', abbreviated '''DLD''', are a group of uncommon pathologies, also known as '''idiopathic interstitial [[pneumonia]]s''', abbreviated '''IIPs''', and '''interstitial lung disease''', abbreviated '''ILD'''.  
 
They are a subgroup of the [[medical lung diseases]].   
 
Diffuse lung disease is the preferred term, as some diseases lumped into this group have involvement of the alveoli, i.e. are not interstitial. Also, some DLDs are not considered idiopathic, e.g. [[DIP]] is caused by [[smoking]].


An introduction to pulmonary pathology is found in the ''[[pulmonary pathology]]'' article.
An introduction to pulmonary pathology is found in the ''[[pulmonary pathology]]'' article.


*Often [[abbreviated]] '''IIP''', is a term used for a type of [[diffuse lung disease]].
=Overview=
**Diffuse lung disease is also known as ''interstitial lung disease''.  
==Specimens==
***Diffuse lung disease is probably a better term... as some diseases lumped into this category have involvement of the alveoli, i.e. are not interstitial.
*Diffuse lung disease is best assessed on an open biopsy.
**These procedure are quite invasive; thus, not infrequently clinicians will try a transbrochial biopsy that ends-up providing in useful information.
 
===Sign out===
<pre>
LUNG, LEFT, TRANSBRONCHIAL BIOPSY:
- SMALL FRAGMENTS OF LUNG PARENCHYMA WITHOUT SIGNIFICANT CHANGES, SEE MICROSCOPIC
  DESCRIPTION AND COMMENT.
 
COMMENT:
The clinical findings are noted. The size and type of biopsy significantly limit the
interpretation.  Suspected diffuse lung disease (interstitial lung disease)
is best assessed on an open lung biopsy.
</pre>
====Micro====
The sections show small fragments of lung parenchyma. A very small amount of anthracotic
pigment is present. Interstitial fibrosis is not apparent. No granulomata are identified.
No nuclear atypia is identified. Air-space macrophages show minimal pigmentation and are
not present in large numbers. No significant airspace or interstitial inflammation is
identified.


==Overivew - histologic classification===
==Histologic classification==
*Can be complex,<ref name="pmid12405906">{{cite journal |author=Nicholson AG |title=Classification of idiopathic interstitial pneumonias: making sense of the alphabet soup |journal=Histopathology |volume=41 |issue=5 |pages=381-91 |year=2002 |month=November |pmid=12405906 |doi= |url=http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0309-0167&date=2002&volume=41&issue=5&spage=381}}</ref> and the combined efforts of [[clinician]]s, [[radiologist]]s, and [[pathologist]]s can help in the generation of a more specific diagnosis.<ref name="pmid15256390">{{cite journal |author=Flaherty KR, King TE, Raghu G, ''et al'' |title=Idiopathic interstitial pneumonia: what is the effect of a multidisciplinary approach to diagnosis? |journal=Am. J. Respir. Crit. Care Med. |volume=170 |issue=8 |pages=904-10 |year=2004 |month=October |pmid=15256390 |doi=10.1164/rccm.200402-147OC |url=http://ajrccm.atsjournals.org/cgi/pmidlookup?view=long&pmid=15256390}}</ref><ref name="pmid16738191">{{cite journal |author=Kim DS, Collard HR, King TE |title=Classification and natural history of the idiopathic interstitial pneumonias |journal=Proc Am Thorac Soc |volume=3 |issue=4 |pages=285-92 |year=2006 |month=June |pmid=16738191 |doi=10.1513/pats.200601-005TK |url=http://pats.atsjournals.org/cgi/pmidlookup?view=long&pmid=16738191}}</ref>
*Can be complex,<ref name="pmid12405906">{{cite journal |author=Nicholson AG |title=Classification of idiopathic interstitial pneumonias: making sense of the alphabet soup |journal=Histopathology |volume=41 |issue=5 |pages=381-91 |year=2002 |month=November |pmid=12405906 |doi= |url=http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0309-0167&date=2002&volume=41&issue=5&spage=381}}</ref> and the combined efforts of [[clinician]]s, [[radiologist]]s, and [[pathologist]]s can help in the generation of a more specific diagnosis.<ref name="pmid15256390">{{cite journal |author=Flaherty KR, King TE, Raghu G, ''et al'' |title=Idiopathic interstitial pneumonia: what is the effect of a multidisciplinary approach to diagnosis? |journal=Am. J. Respir. Crit. Care Med. |volume=170 |issue=8 |pages=904-10 |year=2004 |month=October |pmid=15256390 |doi=10.1164/rccm.200402-147OC |url=http://ajrccm.atsjournals.org/cgi/pmidlookup?view=long&pmid=15256390}}</ref><ref name="pmid16738191">{{cite journal |author=Kim DS, Collard HR, King TE |title=Classification and natural history of the idiopathic interstitial pneumonias |journal=Proc Am Thorac Soc |volume=3 |issue=4 |pages=285-92 |year=2006 |month=June |pmid=16738191 |doi=10.1513/pats.200601-005TK |url=http://pats.atsjournals.org/cgi/pmidlookup?view=long&pmid=16738191}}</ref>


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| [[Desquamative interstitial pneumonia]] (DIP)
| [[Desquamative interstitial pneumonia]] (DIP)
| DIP
| DIP
| Smoking
| [[smoking]]
|-
|-
| [[Diffuse alveolar damage]] (DAD)
| [[Diffuse alveolar damage]] (DAD)
Line 32: Line 56:
| [[Respiratory bronchiolitis]]  
| [[Respiratory bronchiolitis]]  
| [[Respiratory bronchiolitis-associated interstitial lung disease|RB-ILD]]
| [[Respiratory bronchiolitis-associated interstitial lung disease|RB-ILD]]
| Smoking
| smoking
|-
|-
| [[Usual interstitial pneumonia]] (UIP)
| [[Usual interstitial pneumonia]] (UIP)
| [[collagen vascular disease|CVD]], [[idiopathic pulmonary fibrosis|IPF]], [[drug toxicity]], [[pneumoconiosis]]
| [[collagen vascular disease|CVD]], [[idiopathic pulmonary fibrosis|IPF]], [[drug toxicity]], [[pneumoconiosis]]
| Allergen (hypersensitivity pneumonitis), idiopathic, autoimmune
| allergen (hypersensitivity pneumonitis), idiopathic, autoimmune
|-
|-
| [[Organizing pneumonia]]
| [[Organizing pneumonia]]
Line 42: Line 66:
| autoimmune (???)
| autoimmune (???)
|-
|-
| [[Lymphoid interstitial pneumonia]] (LIP)
| [[Lymphocytic interstitial pneumonia]] (LIP)
| LIP
| LIP
| Viral/autoimmune
| viral/autoimmune
|}
|}
ARDS = adult respiratory distress syndrome, AIP = acute interstitial pneumonia, TRALI = transfusion related acute lung injury, CVD = collagen vascular disease, IPF = idiopathic pulmonary fibrosis.
ARDS = adult respiratory distress syndrome, AIP = acute interstitial pneumonia, TRALI = transfusion related acute lung injury, CVD = [[collagen vascular disease]], IPF = idiopathic pulmonary fibrosis.
 


Notes:
Notes:
*''Usual interstitial pneumonia'' is the most common type of ILD.<ref name="pmid16738196">{{cite journal |author=Visscher DW, Myers JL |title=Histologic spectrum of idiopathic interstitial pneumonias |journal=Proc Am Thorac Soc |volume=3 |issue=4 |pages=322-9 |year=2006 |month=June |pmid=16738196 |doi=10.1513/pats.200602-019TK |url=http://pats.atsjournals.org/cgi/pmidlookup?view=long&pmid=16738196}}</ref>
*''Usual interstitial pneumonia'' is the most common type of ILD.<ref name="pmid16738196">{{cite journal |author=Visscher DW, Myers JL |title=Histologic spectrum of idiopathic interstitial pneumonias |journal=Proc Am Thorac Soc |volume=3 |issue=4 |pages=322-9 |year=2006 |month=June |pmid=16738196 |doi=10.1513/pats.200602-019TK |url=http://pats.atsjournals.org/cgi/pmidlookup?view=long&pmid=16738196}}</ref>


==Gross pathologic DDx by location==
Causes of upper lung fibrosis ''FASSTEN'':<ref name=Ref_TN2005_R13>{{Ref TN2005| R13}}</ref>
*[[Farmer's lung]].
*[[Ankylosing spondylitis]].
*[[Sarcoidosis]].
*[[Silicosis]].
*[[Tuberculosis]] (miliary).
*[[Eosinophilic granuloma]].
*[[Neurofibromatosis]].
Causes of lower lung fibrosis ''BAD RASH'':<ref name=Ref_TN2005_R13>{{Ref TN2005| R13}}</ref>
*[[Bronchiolitis obliterans organizing pneumonia]] (BOOP).
*[[Asbestosis]].
*Drugs (nitrofurantoin, hydralazine, isoniazid (INH), amiodarone).
*[[Rheumatologic disease]].
*[[aspiration pneumonia|Aspiration]].
*[[Scleroderma]].
*Hamman-Rich syndrome (really should be -- ''[[idiopathic pulmonary fibrosis]]'').
Note:
*''Hamman-Rich syndrome'' is another name for [[acute interstitial pneumonia]].<ref name=Ref_WMSP90>{{Ref WMSP|90}}</ref>
=Specific diseases/pattterns=
==Diffuse alveolar damage==
*Abbreviated ''DAD''.
{{Main|Diffuse alveolar damage}}
==Usual interstitial pneumonia==
*Abbreviated ''UIP''.
{{Main|Usual interstitial pneumonia}}
==Asbestosis==
{{Main|Asbestosis}}
==Non-specific interstitial pneumonia==
*Abbreviated ''NSIP''.
{{Main|Non-specific interstitial pneumonia}}
==Organizing pneumonia==
{{Main|Organizing pneumonia}}
==Hypersensitivity pneumonitis==
*AKA ''extrinsic allergic alveolitis''
{{Main|Hypersensitivity pneumonitis}}
==Lymphocytic interstitial pneumonia==
*Often abbreviated '''''LIP'''''.
{{Main|Lymphocytic interstitial pneumonia}}
==Respiratory bronchiolitis-interstitial lung disease==
*Abbreviated ''RB-ILD'' or ''RBILD''.
*[[AKA]] ''respiratory bronchiolitis-associated interstitial lung disease''.
{{Main|Respiratory bronchiolitis-interstitial lung disease}}


==Desquamative interstitial pneumonia==
*Abbreviated ''DIP''.
{{Main|Desquamative interstitial pneumonia}}


==See also==
=See also=
*[[Medical lung diseases]].
*[[Medical lung diseases]].
*[[Pulmonary pathology]].
*[[Pulmonary pathology]].


==References==
=References=
{{Reflist|2}}
{{Reflist|2}}


[[Category: Pulmonary pathology]]
[[Category: Pulmonary pathology]]
Michael
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