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Steps to diagnose and Signs ILD in practice Part 2 - Dr. Sheetu Singh

Steps to Diagnose and Signs ILD in Practice Part 2 - Dr. Sheetu Singh Visit drsheetusingh.com for more info.

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Steps to diagnose and Signs ILD in practice Part 2 - Dr. Sheetu Singh

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  1. Physical examination • Clubbing • “Velcro rales” or “Basal crepitations” are common in most forms of ILD • Inspiratory squeaks: characteristic of hypersensitivity pneumonitis • Cor pulmonale • Cyanosis in late stage of ILD • Extrathoracic findings: directive but not diagnostic • Presence of lymphadenopathy with ophthalmological / dermatological manifestations points to sarcoidosis.

  2. Diagnostic algorithm for evaluation of ILD Cough and Exertionaldyspnoea Chest radiograph, PFT, 6MWT Either reticular/nodular/cystic shadow on CXR OR Restrictive spirometry & diffusion defect OR Desaturation on 6MWT dUIP →IPF CTD-ILD HRCT Chest Confident clinical diagnosis* Sarcoid, HP, PAP, Lymphangitis carcinomatosis Other idiopathic IIP Bronchoscopy BAL, Endobronchial biopsies, TBLB, EBUS-TBNA Open lung or VATS assisted lung biopsy or Transbronchial cryobiopsy If inconclusive

  3. Investigations directive towards a diagnosis of ILD • Chest X ray • Spirometry • Six minute walk test

  4. 1. Chest radiograph • Review all previous films to assess the rate of change in disease activity • Chest radiograph is normal in 10% of patients with ILD (particularly those with HP).

  5. Radiological clues to diagnosis of ILD

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