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تعداد آیتم قابل مشاهده باقیمانده : 1 مورد

Diagnostic evaluation of patients with unclassified interstitial lung disease

Diagnostic evaluation of patients with unclassified interstitial lung disease
This algorithm represents our approach to the diagnostic evaluation of patients presenting with suspected ILD of unknown classification or etiology. This algorithm is intended for use in conjunction with additional information provided in UpToDate content on the clinical manifestations and diagnosis of ILD.

ANA: antinuclear antibody test; BAL: bronchoalveolar lavage; COP: cryptogenic organizing pneumonia; cryo-TBB: transbronchial cryobiopsy; DIP: desquamative interstitial pneumonitis; EBUS: endobronchial ultrasound; HP: hypersensitivity pneumonitis; HRCT: high-resolution computed tomography; IIP: idiopathic interstitial pneumonia; ILD: interstitial lung disease; IPF: idiopathic pulmonary fibrosis; NSIP: nonspecific interstitial pneumonia; PLCH: pulmonary Langerhans cell histiocytosis; TBB: transbronchial lung biopsy; UIP: usual interstitial pneumonia.

* ILD protocols for HRCT of the chest include volumetric inspiration, expiration, and prone imaging to assess for air-trapping, small airways disease, and dependent atelectasis.

¶ Additional testing for connective tissue disease and myositis may be performed either during the initial work-up, especially for those with demographic or known imaging features atypical for IPF, or as indicated by clinical or radiologic findings after the initial work-up. This testing includes creatine kinase, aldolase, myositis/antisynthetase antibody panel, and an extractable nuclear antigen antibody panel (including Sjögren-associated antibodies [anti-Ro60, anti-Ro52, and anti-La] and scleroderma-associated antibodies [anti-SCL-70 and anti-centromere]).

Δ Common environmental or iatrogenic etiologies include: drug toxicities (bleomycin, immune checkpoint inhibitors, nitrofurantoin, nitrosoureas), radiation therapy to the thorax, inhaled inorganic dusts (eg, silica, asbestos, beryllium, coal), and inhaled organics (hay and grains, humidifiers/indoor pool, feathers, molds). Any of these exposures in the setting of appropriate history and imaging findings may explain the presence of ILD.

◊ Features of definite and probable UIP include: reticular opacities in a basal and peripheral distribution, traction bronchiectasis, honeycombing (clustered airspaces 3 to 10 mm diameter) in a subpleural location, and lack of extensive ground-glass opacities.

§ IIPs are non-granulomatous diffuse parenchymal lung disease of unknown etiology, including: IPF, NSIP, COP, acute interstitial pneumonia, respiratory bronchiolitis ILD, and DIP.

¥ For patients who have a nondiagnostic cryo-TBB, subsequent surgical lung biopsy may be appropriate to obtain a diagnosis.

References:
  1. Raghu G. Interstitial lung disease: A diagnostic approach. Are CT scan and lung biopsy indicated in every patient? Am J Respir Crit Care Med 1995; 151:909.
  2. Raghu G, Remy-Jardin M, Myers JL, et al. Diagnosis of idiopathic pulmonary fibrosis. An official ATS/ERS/JRS/ALAT clinical practice guideline. Am J Respir Crit Care Med 2018; 198:e44.
  3. Hariri LP, Roden AC, Chung JH, et al. The role of surgical lung biopsy in the diagnosis of fibrotic interstitial lung disease: Perspective from the Pulmonary Fibrosis Foundation. Ann Am Thorac Soc 2021; 18:1601.
  4. Dias Rohr JT, Rodrigues Isaac C, de Almeida de Lima A, et al. Study of geometric illusory visual perception - A new perspective in the functional evaluation of children with strabismus. Front Hum Neurosci 2022; 16:769412.
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