This article is to discuss lung fibrosis regarding its known types , aetiology, clinical picture (manifestations), investigations and management .
1• Interstitial pulmonary fibrosis .
2• Parenchymatous pulmonary fibrosis .
Clinical picture
Pulmonary fibrosis (parenchymatous)
1- Manifestations of the cause or past history of TB - lung abscess - Bronchiectasis - Empyema
2- Dyspnea, chronic dry cough .
3- Cyanosis (In advanced stage)
Local examination
(The affected side showing multiple negative signs):
• Inspection : Diminished movement, retraction.
• Palpation : TVF Low, diminished chest expansion, trachea deviated to the same side of the lesion.
TVF is High with Marked tracheal shift to the same side
• Percussion : Dullness, if the fibrosis is left sided it does not affect the traube's area (resonant traube's area), to be differentiated
from left sided pleural effusion.
• Auscultation : Diminished Air entery - or diminished intensity of breath sounds, coarse non consonating crepitations .
Investigations
* X-ray shows :
Crowded ribs, trachea shifted to the same side , Heterogenous opacity, Tenting of diaphragm
* Pulmonary function tests showing restrictive hypoventilation.
• Symptomatic treatment e.g. antitussive for cough
• Treatment of complications e.g cor pulmonale and respiratory failure.
• Lung transplantation in advanced cases.
Types of pulmonary fibrosis
1• Interstitial pulmonary fibrosis .2• Parenchymatous pulmonary fibrosis .
Etiology ( Causes of pulmonary fibrosis ):
TB - lung abscess - Bronchiectasis - EmpyemaClinical picture
Pulmonary fibrosis (parenchymatous)
1- Manifestations of the cause or past history of TB - lung abscess - Bronchiectasis - Empyema
2- Dyspnea, chronic dry cough .
3- Cyanosis (In advanced stage)
Local examination
(The affected side showing multiple negative signs):
• Inspection : Diminished movement, retraction.
• Palpation : TVF Low, diminished chest expansion, trachea deviated to the same side of the lesion.
TVF is High with Marked tracheal shift to the same side
• Percussion : Dullness, if the fibrosis is left sided it does not affect the traube's area (resonant traube's area), to be differentiated
from left sided pleural effusion.
• Auscultation : Diminished Air entery - or diminished intensity of breath sounds, coarse non consonating crepitations .
Investigations
* X-ray shows :
Crowded ribs, trachea shifted to the same side , Heterogenous opacity, Tenting of diaphragm
* Pulmonary function tests showing restrictive hypoventilation.
Treatment of pulmonary fibrosis
• Treatment of the cause if possible.• Symptomatic treatment e.g. antitussive for cough
• Treatment of complications e.g cor pulmonale and respiratory failure.
• Lung transplantation in advanced cases.