IIP Final - DM SEMINAR AUGUST 13, 2004 IDIOPATHIC...

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IDIOPATHIC INTERSTITIAL PNEUMONIAS - UPDATE Navneet Singh Department of Pulmonary Medicine DM SEMINAR AUGUST 13, 2004
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HEADINGS • INTRODUCTION • CLASSIFICATION • APPROACH TO PATIENT WITH IIP • CLINICAL-RADIOLOGICAL- HISTOPATHOLOGICAL FEATURES OF INDIVIDUAL IIPS • TREATMENT
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INTRODUCTION
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INTRODUCTION • 1892 - Osler initially described chronic interstitial pneumonia as cirrhosis of the lung • 1944 - Hamman and Rich described 4 cases of diffuse interstitial fibrosis that were acute in onset and rapidly progressive Æ Hamman - Rich Sydnrome for any acute onset diffuse idiopathic fibrotic lung disease
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INTRODUCTION WHAT ARE IIPs? • Heterogenous group of clinicopathologic entities • Broadly classified under Diffuse Parenchymal Lung Diseases ( DPLD s) • Non-neoplastic in nature • Can be differentiated from other DPLDs by clinical symptoms and signs, chest radiology, laboratory investigations and histopathological examination
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INTRODUCTION • Idiopathic = Unknown • Interstitial pneumonia = Involvement of lung parenchyma by varying combinations and patterns of inflammation and fibrosis • Primary site of injury – Intersititum (Space between epithelial and endothelial basement membranes) • Airspaces, peripheral airways and vessels along with their respective epithelial and endothelial linings also frequently involved
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CLASSIFICATION
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CLASSIFICATION 1969 - Initial classification given by Liebow and Carrington : 1. Usual Interstitial Pneumonia ( UIP ) including acute form (Hamman-Rich Syndrome) 2. Desquamative Interstitial Pneumonia ( DIP ) 3. Bronchiolitis Obliterans Interstitial Pneumonia ( BOOP ) and Diffuse Alveolar Damage ( DAD ) 4. Lymphoid Interstitial Pneumonia ( LIP ) 5. Giant Cell Interstitial Pneumonia
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CLASSIFICATION 1998 Katzenstein and Meyers proposed: 1. UIP 2. DIP & RB-ILD (Respiratory Bronchiolitis - associated Interstitial Lung Disease) 3. Acute Interstitial Pneumonia ( AIP ) – formerly Hamman-Rich Syndrome 4. Non Specific Interstitial Pneumonia ( NSIP ) LIP and Giant Cell Interstitial Pneumonia removed because no longer considered idiopathic (lymphoproliferative disorder and hard metal pneumoconiosis respectively)
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CLASSIFICATION 1997 Muller and Colby – similar to Katzenstein/Meyers (addition of BOOP) 2001 ATS/ERS International Multidisciplinary Consensus Classification - reasons for new classification Æ improvement in understanding of clinical, radiological and histological patterns of IIPs with increasing use of HRCT and VATS- Lung Bx. CRP (clinico-radiologic-pathologic diagnosis) and histologic patterns for each of the CRP.
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CLASSIFICATION CRP Diagnosis • IPF/CFA • NSIP (Provisional) •C O P / B O O P •A I P • RB-ILD •D I P •L I P Histologic Pattern •U I P •N S I P • Organizing pneumonia A D •R B I P I P
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DIAGNOSTIC APPROACH
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DIAGNOSTIC APPROACH
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DIAGNOSTIC APPROACH
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DIAGNOSTIC CRITERIA - IPF (NO OPEN LUNG Bx)
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INDIVIDUAL IIPs
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CLINICAL FEATURES - IIPs IPF NSIP BOOP AIP RB-ILD DIP LIP Age 5 th -6 th Dec 4 -5 Dec 6 Dec Any (av 50 yr) 4 Dec 4 Dec 5 Dec
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This note was uploaded on 12/03/2011 for the course MEDICINE 350 taught by Professor Dr.aslam during the Winter '07 term at Medical College.

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IIP Final - DM SEMINAR AUGUST 13, 2004 IDIOPATHIC...

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