文档介绍：Case Study
Chief Complaint: 62-year-old man with progressive shortness of breath over the past 2 years
History of Present Illness: Two years before patient began having shortness of breath (SOB). The SOB had become progressively worse in the past 12 months. A month prior to presentation, he developed severe SOB requiring admission to a local hospital.
The patient reported no exposures related to hypersensitivity pneumonitis including birds, mold. His only chemical exposure was to malathion he sprayed in his backyard garden.
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Past Medical & Surgical History: unremarkable
Allergies: Penicillin
Medicines:Nifedipine ,Furosemide ,Statin
Family History: Negative for lung disease or rheumatologic processes
Social History: 30 pack-years cigarette consumption and stopped 15 years earlier
Travel History: Negative
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Physical Examination:
General: well appearing
Vital Signs: BP: 110/70 ,Pulse: 85 RR ,26 breaths/minute
HEENT: No skin tightness around his mouth
Neck: No jugular vein distention
Cardiovascular System: No findings of pulmonary hypertension
Respiratory System: Inspiratory crackles over lower half of chest
Extremities: clubbing
Musculoskeletal System: no arthritis or synovitis
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Laboratory Workup: ANA negative, speckled pattern with a negative Sm antibody, negative Scl-70 antibody; an echocardiogram revealed an estimated mean pulmonary artery pressure of 55 mmHg.
Initial PFT Data:
FVC 63% of predicted ,FEV1/FVC 85%
DLCO 30% of predicted
TLC 54% of predicted
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HRCT FINDINGS
Slide courtesy of G Raghu, MD.
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间质性肺疾病 （Interstitial Lung Disease,ILD)
北京医院呼吸科与危重症医学科 许小毛
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什么是肺间质
肺泡间及终末气道上皮以外的支持组织，包括血管及淋巴管组织。
肺实质指各级支气管及肺泡结构。
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概述
以肺泡壁为主并包括肺泡周围组织及其相邻支持结构病变的一组疾病群,病因近200种。
由于病变不仅局限于肺泡间质,还可累及肺泡上皮细胞、肺毛细血管内皮细胞和细支气管,并常伴有肺实质受累如肺泡炎、肺泡腔内蛋白渗出等改变,故也称为弥漫性肺实质疾病(Diffuse Parenchymal Lung Disease,DPLD)
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