Diagnostic studies-interstitial lung disease

see Appendix & Radiology inserts)

• CXR and high-resolution chest CT

Upper lobe predom: hypersensitivty, coal, silica, smoking-related, sarcoidosis, Langerhan’s

Lower lobe predom: NSIP, UIP, asbestosis

Adenopathy: malignancy, sarcoidosis, berylliosis, silicosis

Pleural disease: collagen-vascular diseases, asbestosis, infections, XRT

• PFTs: ↓ DLCO (early sign), restrictive pattern (↓ volumes), ↓ PaO2 (esp. w/ exercise);

If restrictive + obstructive, consider sarcoid

If combined pulmonary fibrosis and emphysema (CFPE) → near-nl lung vol on PFTs

• Serologies: ✓ ACE, ANA, RF, RNP, ANCA, CCP, SSA/SSB, Scl 70, CK, aldolase, myositis panel

• Bronchoalveolar lavage: in select cases if suspect superimposed infection, hemorrhage, eosinophilic syndromes

• Bx (transbronch w/ or w/o cryo vs. VATS depending on location) if unclear etiology