Rule-out mimickers of ILD
• Congestive heart failure
• Infection viral (influenza, parainfluenza, adenovirus, coronavirus. RSV. CMV) bacterial (especially atypicals such as Mycoplasma. Chlamydia, and Legionella) fungal (PCP. histoplasmosis, coccidioidomycosis); mycobacterial (MTb and MAI) parasitic (see Loffler s syndrome below)
• Malignancy lymphangitic carcinomatosis: adenoCa (breast, pancreas, stomach, lung) ■ squamous bronchoalveolar cell carcinoma (although usually appears as air-space disease) lymphoproliferative disorders (leukemia and lymphoma)
History and physical exam
• Occupational, travel, exposure, medications, precipitating event
• Tempo (acute — infection, CHF. hypersensitivity pneumonitis, eos PNA.AIP. COP)
• Extrapulmonary s/s (skin As. arthralgias/arthritis, neuropathies, etc.) Diagnostic studies
• CXR and high-resolution chest CT: reticular, nodular, or ground glass pattern upper • coal, silicosis, hypersens., sarcoid.TB, RA. LCG; lower IPF, asbestosis adenopathy — sarcoidosis, berylliosis, silicosis, malignancy, fungal infections pleural disease — collagen-vascular diseases, asbestosis. infections. XRT
• PFTs: restrictive pattern (i volumes), i DiCO, i P4Oj (especially w/ exercise)
• Serologies: ✓ ACE. ANA. RF.ANCA, anti-GBM, HIV
• Bronchoalveolar lavage: dx in infections, hemorrhage, PIE syndromes. PAP
• Biopsy (transbronchial. CT-guided.VATS. open): dx in granulomatous diseases (sarcoid.
hypersens.. Wegener's. Churg-Strauss. LCG). pneumoconioses. IIPs. infection, malig . . consider if no clear precipitant and noninvasive workup unrevealing
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