The Interstitial Lung Diseases (ILDs) confuse the heck of me. There's a billion different types of ILD and it just becomes a cryptococcal-silcosis-COP/BOOP mix of gobbledy-gook.
We had a patient who presented with 2 weeks of dyspnea and was found to have ground glass opacities on CT with interseptal thickening. We called a pulm consult, and the fellow was kind enough to give a simplified breakdown of the chronic ILDs.
2 main types of chronic ILD:
1) UIP (Usual interstitial pneumonitis) - the BAD one
- more scarring seen on chest CT
- not steroid responsive
- usually fatal within 2 years unless lung transplant
2) NSIP/COP (Nonspecific interstitial pneumonia/crytogenic organizing pneumonia)
- more ground glass opacities seen on chest CT
- steroid responsive
- better outcome
Distinguishing the two requires a VATS for tissue biopsy. Alteratively, start a trial of prednisone (1 mg/kg) for 4 weeks, with a max of 60 mg/day, tapered to 40 mg per day for the next 2 weeks. Don't forget about PCP prophylaxis, with 1 DS Bactrim MWF.
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