0 What are the main symptoms of interstitial pneumonia?
Interstitial pneumonia collectively belongs to the family of interstitial lung diseases, and because it is the most common, it is a frequently encountered and confusing problem for clinicians and patients. Interstitial pneumonia is clinically divided into two categories: those with a definite cause and those with an unknown cause. One category is general viral or bacterial infections or certain known causes of inflammation occurring predominantly in the interstitial lung; the other category is interstitial pneumonia of unknown cause, collectively referred to as idiopathic interstitial pneumonia, and such diseases are classified according to their pathogenesis, clinical features and pathological changes as idiopathic pulmonary fibrosis, acute interstitial pneumonia, etc. The clinical symptoms common to all interstitial pneumonia are progressive or acute onset dyspnea, followed by cough, which starts as a dry cough and with secondary infection may present with yellow sputum, fever, hemoptysis, and chest pain.
Do all patients have pestle finger?
No, only patients with chronic hypoxia who have been ill for a long time can develop pestle finger, and this sign is not necessarily related to interstitial pneumonia.
What are the differences between acute interstitial pneumonia?
Acute interstitial pneumonia has a rapid onset, short course, and rapid progression, and if it is not controlled effectively and in a timely manner, respiratory failure can occur quickly and can be life-threatening. At this time, the lesions in the lungs are dominated by acute alveolar damage, and if treated promptly, the prognosis can often be improved and the patient’s life saved. If the disease has progressed to the fibrosis stage, treatment at this time cannot reverse the disease, but merely slows the progression of the lesion.
Can the diagnosis of interstitial pneumonia be confirmed by routine chest X-rays and CT lung examinations when symptoms such as shortness of breath, cough and sputum occur?
Because of the fine interstitial lattice, ordinary chest X-ray has low resolution, making it difficult to accurately determine the lesions of interstitial pneumonia at an early stage. The most ideal test to diagnose interstitial pneumonia is high-resolution lung CT (i.e., HRCT), often called thin-layer high-resolution CT. In medical units without such a condition, at least a plain CT scan should be done, and in medical units without a CT machine, a plain chest X-ray can be done to understand the basic lesions of the lungs.
Can arterial blood gas analysis indicate interstitial pneumonia? Do I need to have other blood tests?
Arterial blood gas analysis is not indicative of interstitial pneumonia, as many diseases can have abnormal blood gases. However, patients with suspected interstitial pneumonia must have an arterial blood gas analysis to determine oxygenation, to understand the severity of the disease, and to help determine the effectiveness of treatment and prognosis. In addition to blood gas, laboratory tests are also required: routine blood, liver and kidney function, DIC, screening pathogens such as HIV, SARS, CMV, immunology, and other inflammatory markers such as PCT and CRP.
What is the significance of pulmonary function tests for the diagnosis of interstitial pneumonia?
It can help to understand the current lung function impairment, not only the ventilation function but more importantly the diffusion function, which can help to determine the severity of interstitial damage.
What is the bronchoalveolar perfusion test? What is its significance for the diagnosis of interstitial pneumonia?
Bronchoalveolar lavage is the selective flushing of the lesion using sterile saline while doing bronchoscopy, and then collecting the lavage fluid and sending it for certain special items; in acute interstitial pneumonia, it often cannot withstand bronchoscopy due to the severity of the disease, but bronchoscopy can be performed after the disease is relatively stable. Collecting the lavage fluid and sending it for cytologic classification, Pneumocystis carinii, PAS staining and Lymphocyte subsets can help the physician diagnose and rule out certain diseases.
Is a lung biopsy necessary for interstitial pneumonia? When is a lung biopsy necessary?
The need for a lung biopsy in interstitial pneumonia depends on whether the diagnosis is clear. Since 2011, the international academic community has standardized guidelines that not all cases of interstitial pneumonia require a lung biopsy. For example, idiopathic pulmonary fibrosis can be diagnosed when there are typical HRCT changes in the lungs and secondary causes are ruled out; in addition, most cases with a clear etiology do not require lung biopsy. Only when interstitial pneumonia of clear etiology has been ruled out and still cannot be categorized will a lung biopsy be needed to aid in the diagnosis, along with pathologic information.
What are the ways to get a lung biopsy? How to choose?
In the past, open lung biopsies were mostly performed. Although this approach provides a good view and obtains more lung tissue, it is invasive, slow to heal, and prone to complications, which is often difficult for patients to accept; in recent years, in addition to the classic open lung biopsy, lung tissue can be obtained through percutaneous lung puncture and thoracoscopic lung biopsy. In particular, thoracoscopic lung biopsy is currently the most commonly used modality for lung biopsy because of the small incision, rapid healing, few complications, and the ability to meet the requirement for a sufficiently sized lung tissue sample.
What stages of interstitial pneumonia can be classified? What are the principles of treatment for the different stages?
Interstitial pneumonia differs from tumors in that there is no absolute stage. Therefore, clinically different clinical strategies are used for different prognoses of the disease.
Self-limiting inflammation/stable fibrosis: observation.
predominantly inflammatory (mostly reversible) with varying degrees of fibrosis: aggressive treatment with maintenance of outcome once goals are reached.
progressive progressive fibrosis with the possibility of gradually reaching a steady state: treatment to prevent its progression
Fibrosis that is not terminable: treatment to allow its slow progression.
In clinical practice, it is often divided into an acute phase, a stable phase, and an acute exacerbation phase. The acute and acute exacerbation phases should be treated early and aggressively, especially with high doses of glucocorticoids, and ensuring anti-inflammatory, adequate oxygen therapy, etc. The treatment of the stable phase depends on the primary disease, if there is rheumatic immune disease, it is necessary to continue the treatment of the primary disease. In addition, regardless of the etiology, long-term antioxidants can be taken, such as: Fullux, 600 mg, two to three times a day.