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Suspect CTD ILD Steps to diagnose ILD Part 4 Dr. Sheetu singh

Suspect CTD ILD Steps to Diagnose ILD Part 4 Dr. Sheetu Singh Visit Our Website and book appointment for ILD Test - www.drsheetusingh.com

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Suspect CTD ILD Steps to diagnose ILD Part 4 Dr. Sheetu singh

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  1. Confirm ILD Suspect ILD Cough, Exertionaldyspnea Velcro crepitations CXR and spirometry abnormal Exercise desaturation HRCT scan Smoking history Clinical history CTD history Classify ILD Treat ILD Exposure history Histopathology findings

  2. To confirm a diagnosis of ILD and its sub-type is no less than the work of Sherlock Holmes! Pick up innocuous looking CLUES

  3. CLUE 1: Age of patient >50 years - IPF 20-40 years – Sarcoidosis CTD-ILD

  4. CLUE 2: Gender of patient Females • CTD-ILD • LAM Males • IPF • Pneumoconiosis • RA associated ILD

  5. CLUE 3: Onset of illness Acute (days to weeks) < 3 WKS • Hypersensitivity pneumonitis Subacute (weeks to months) 3-12 WKS • Sarcoidosis • Connective tissue disease • Some drug-induced ILDs • Cryptogenic organizing pneumonia Chronic (months to years) >12 WKS • Idiopathic pulmonary fibrosis • Sarcoidosis

  6. CLUE 4: Smoking history Smokers: • IPF Non smokers: • HP • Sarcoidosis

  7. Clue 5: History suggestive of connective tissue disease • Rheumatoid arthritis – small joint pains • Scleroderma – raynaud’s phenomenon, tightening of skin, history suggestive of GERD • Dermatomyositis – skin changes • Sjogren’s syndrome – ocular symptoms, drying of mouth, joint pains

  8. Suspect CTD ILD (One in any two) A. Clinical (any one) 1. Distal digital fissuring (“mechanic hands”) 2. Distal digital tip ulceration 3. Arthritis or morning joint stiffness ⩾60 min 4. Palmartelangiectasia 5. Raynaud’s phenomenon 6. Unexplained digital oedema 7. Unexplained fixed rash on the digital extensor surfaces (Gottron’s sign) B. Serologic (any one) 1. ANA ⩾1:320 2. Rheumatoid factor 3. Anti-CCP C. Morphologic (any one) CT pattern: NSIP, OP, LIP Multicompartment: Unexplained pleural or pericardial: effusion or thickening

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