dermatomyositis and interstitial lung disease

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1、DermatomyositisandinterstitiallungdiseaseAsminTulpule,HMSIIINovember16,2009CoreRadiologyClerkshipAgenda•Presentationofourpatient•Menuofradiologictests•Basicsofinterstitiallungdisease(ILD)•RadiologicsurveyofILD•Applicationofradiologicfindingstoourpatient’sclinicalcourseOurpatient:

2、Initialreport•Ms.Lisa57yearoldFwitharecentdiagnosisofdermatomyositis(DM)andILDtransferredtoBIDMCforworseningdyspneaandhypoxiaoverthepast2-3days•InitialdiagnosisofDMtwomonthspriorbasedonmyalgias,Gottron’spapules,andheliotroperash.Confirmedbyskinbiopsy.Heliotroperash•Norespiratoryc

3、omplaintsatfirstandinitialCTscanatOSHshowedmildILD.Startedon40mgprednisone.http://www.jfponline.com/images/5502/5502JFP_FMGrandRounds-fig1.jpgNote:DMisanidiopathicinflammatorymyopathywithastrongassociationwithILD(30-40%)characterizedbypulmonaryfibrosis,aswellasapredispositiontode

4、velopingvisceralmalignancies(stomach,pancreas).Ourpatient:PastMedicalHx•Begandevelopingdyspneaonexertionafteramonth.ThoughttobeprogressingpulmonaryfibrosisassociatedwithDM.Receivingincreasingprednisone(upto60mgPOqday)andstartedonintermittentinfusionsofSolumedrol.Shewasalsotriedon

5、IVIGandazathioprineforILDassociatedwithDM.Herrespiratorystatusdidnotimprove.•ShewasNOTplacedonanyantibioticprophylaxis•Shereportsnightsweatsforthepasttwomonths.Shedeniesanyfevers,chills,orsymptomsofGIillness.•Nopriorhistoryofsmoking.Norecentinternationaltravelhistory.Ourpatient:I

6、nitialEvaluation•Onthefloor,shereportsanacute2-3dayworseningofrespiratorystatus.Sheisnolongerabletowalkmorethanafewstepswithoutdevelopingacuteshortnessofbreath.PhysicalExam:VitalSigns:Tc97.2BP117/79HR77RR24O2sat:93%on6Land70%FMGEN:Illappearing,speakinginfullsentencesbutappearsdys

7、pneicwithconversation,occasionallystoppingtocatchherbreathLungs:clearanteriorly.Posteriorfinecracklesmidandlowerlungfields.Nowheezesorrhonchi.Cardiac:RRR.Nom/r/g.ProminentS2Let’snowdiscussthemenuofradiologicteststhatcouldhelpaidusinthediagnosisandmanagementofourpatient.Agenda•Pre

8、sentationofourpatient•Menuofradiologicte