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

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 Exertional dyspnoea
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

1. Chest X ray
2. Spirometry
3. 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