11 Restrictive
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Last updated
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normal DLCO: alveoli working
emphysema: destruction of alveoli, low DLCO
abnormal vasculature with impaired ability of blood to pick up CO
lung resection: healthy alveoli, just less
anemia: not enough RBC to pick up CO
asthma: high DLCO due to more capillaries
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pathologic process starting in interstitium, misleading because often involves destruction of alveoli
sticky, fibrous, inflammatory tissue, prevents lung inflation
right: streaky infiltrates with dark stuff (honeycombing)
left: white stuff with holes (honeycombing)
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IPF: fibrous tissues diffusely laid down in lungs, hard to breath
scleroderma/RA can involve lung
Goodpasture/Wegener: antibodies involve lung
sarcoidosis: granulomas inside lung
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collection of different disorders
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upper lobe preference
metal castings made of silica
high TB prevalence in silicosis
Silicosis is distinguished by calcification of the rim of hilar nodes (eggshell calcification) and birefringent silica particles surrounded by fibrous tissue on histology. It has long been associated with increased risk of tuberculosis.
Silicosis impairs the macrophage effector arm of cell-mediated immunity, which is integral to the immune response against mycobacteria. It is thought that macrophage phagolysosomes are disrupted by internalized silica particles, causing release of the particles and viable mycobacteria, which inhibits the immune system's ability to control the infection. This extracellular release of lysosomal enzymes is thought to contribute to alveolar and interstitial lung injury in silicosis. Prolonged exposure of macrophages to silica particles also appears to increase macrophage apoptosis.
well circumscribed
asbestos: for insulation
pleural plaques: white arrow
white stuff at edges (black arrow)
see white at edges in occupational worker, think asbestosis
left: after phagocytosed
greatest risk is bronchogenic carcinoma
see pleural effusion in asbestosis worker, think mesothelioma
chest pain: pleural involved, stretched
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Fibrotic lung embroidery: amiodarone can cause pulmonary fibrosis
Tight button: amiodarone induced lung fibrosis causes restrictive lung disease
Beluga whale: bleomycin (antitumor antibiotic)
Lung coral: bleomycin can cause pulmonary toxicity (e.g. pneumonitis, pulmonary infiltrates)
Beautiful sirens: busulfan (cytotoxic alkylating agent)
Fibrotic lung pattern: busulfan can cause lung toxicity (e.g. acute lung injury, interstitial fibrosis, alveolar hemorrhage)
Fibrotic lung bonsai: MTX can cause pulmonary fibrosis (restrictive lung disease)
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