Interstitial Lung Disease

Workup of ILD (Thorax 2008;63:v1)

May present as incidental finding, subacute dyspnea, or rapidly progressive hypox. resp fail.

Broad categories

  • (1) Sarcoid; (2) Exposure-related (eg, drugs, XRT, organic & inorganic dusts);
    • (3) Collagen vascular dis. (eg, scleroderma, GPA, RA); (4) Idiopathic PNAs (eg, IPF)

Rule out mimickers of ILD

  • Congestive heart failure (✓ BNP, trial of diuresis); infection: viral, atypical bacterial; malignancy: lymphangitic carcinomatosis, bronchoalveolar, leukemia, lymphoma

History and physical exam

  • Occupational, exposures (eg, birds), tobacco, meds, XRT, FHx, precipitating event
  • Tempo (acute → infxn, CHF, hypersens pneumonitis, eos PNA, P, COP, drug-induced)