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Pulmonary fibrosisAbnormal formation of fibre like scar tissue in the lung
May take 3 forms
REPLACEMENT FIBROSIS
FOCAL FIBROSIS
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INTERSTITIAL FIBROSIS--- Content provided by FirstRanker.com ---
Replacement fibrosis
Fibrous tissue is laid down in the areas of lung destruction
Clinical signs
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Chest is asymmetrical with flattening of the affected sideDrooping of shoulder
Decreased movement
Trachea and the mediastinal structures are pul ed
towards the same side
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Percussion note is diminishedVocal fremitus and vocal resonance depend on the severity of
fibrosis . In severe fibrosis they are decreased
In extensive fibrosis the breath sounds are considerably diminished
Adventitious sounds may be heard
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Interstitial fibrosis
Interstitial lung disease may result from connective
tissue disorders like progressive systemic sclerosis,
collagen vascular disease, sarcoidosis,
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chronic pulmonary edema etc50% occur without any identifiable cause and are known as
idiopathic pulmonary fibrosis
In all these cases there is increased deposition of fibrous tissue in the
interstitium which affect the diffusion of oxygen across alveolar
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membrane--- Content provided by FirstRanker.com ---
Clinical signs
Gross clubbing
Tachypnoea
Cyanosis
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Decreased respiratory movementsSince these changes affect both lungs there is NO marked shift of
midline structures
Breath sounds are decreased
Diffuse rales which persist after coughing are characteristic
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The characteristic end inspiratory Velcro crackles are present in IPF--- Content provided by FirstRanker.com ---
Chest x ray shows generalised loss
PFT shows restrictive pattern usually
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of translucency and increaseddecreased vital capacity
reticulations
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In advanced cases of ILD traction
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Cardiac findings includebronchiectasis and subpleural
honeycombing may be seen
right ventricular hypertrophy
Loud pulmonic second sound
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Pulmonarycollapse
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When a portion of the lung becomes airless,it is termed as
pulmonary collapse or atelectasis
Causes include foreign body, tumors of bronchus, copius
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secretions,p neumothorax and pleural effusion--- Content provided by FirstRanker.com ---
Clinical findings
Symptoms depend on the extent of the collapse and its onset
Acute lesions are more symptomatic
Massive collapse lead to dyspnoea with or without cyanosis
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Movement of the affected side is reduced and the chest is flattenedTrachea and cardiac apex is shifted to the same side
Percussion note over the affected side is reduced
Breath sounds are diminished or absent
Adventitious sounds are absent
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Chest XrayDirect signs
Indirect signs
q Displacement of the interlobar
q Elevation of hemidiaphragm
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fissureq mediastinal displacement
q Loss of aeration
q Hilar displacement
q Vascular and bronchial signs
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q Compensatory hyperinflation--- Content provided by FirstRanker.com ---
Patterns
Complete lung collapse
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Partial lung collapse--- Content provided by FirstRanker.com ---
Golden's S sign
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Juxtaphrenic peak sign