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

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Suspect ILD
Confirm ILD

1. Cough, Exertional dyspnea
2. Velcro crepitations
3. CXR and spirometry abnormal
4. Exercise desaturation

HRCT scan
Smoking history
Clinical history
CTD history
Classify ILD
Treat ILD
Exposure history
Histopathology findings
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To confirm a diagnosis of ILD and its sub-type is
no less than the work of Sherlock Holmes!
Pick up innocuous looking CLUES
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CLUE 1 Age of patient

• gt50 years - IPF

• 20-40 years Sarcoidosis
• CTD-ILD

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CLUE 2 Gender of patient

• Females
• CTD-ILD
• LAM

• Males
• IPF
• Pneumoconiosis
• RA associated ILD

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CLUE 3 Onset of illness

• Acute (days to weeks) lt 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) gt12 WKS
• Idiopathic pulmonary fibrosis
• Sarcoidosis

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CLUE 4 Smoking history

• Smokers
• IPF

• Non smokers
• HP
• Sarcoidosis

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Clue 5 History suggestive of connective tissue
disease

• Rheumatoid arthritis small joint pains
• Scleroderma raynauds phenomenon, tightening of
  skin, history suggestive of GERD
• Dermatomyositis skin changes
• Sjogrens syndrome ocular symptoms, drying of
  mouth, joint pains

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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. Palmar telangiectasia
• 5. Raynauds phenomenon
• 6. Unexplained digital oedema
• 7. Unexplained fixed rash on the digital extensor
  surfaces (Gottrons sign)
• B. Serologic (any one)
• 1. ANA ?1320
• 2. Rheumatoid factor
• 3. Anti-CCP
• C. Morphologic (any one)
• CT pattern NSIP, OP, LIP
• Multicompartment Unexplained pleural or
  pericardial effusion or thickening