download - Malaysian Thoracic Society
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Annual Congress of <strong>Malaysian</strong> <strong>Thoracic</strong> <strong>Society</strong><br />
Symposium 2B<br />
Interstitial Lung Diseases<br />
Rational and systematic evaluation of patients suspected of DPLD<br />
Tengku Saifudin Tengku Ismail<br />
Malaysia<br />
The diagnosis of DPLD requires a multidisciplinary approach between clinicians, radiologists and pathologists.<br />
A meticulous history including occupational and environmental exposures, documenting drug exposures,<br />
eliciting signs and symptoms of collagen vascular disease or other primary diseases may provide a clue<br />
towards the diagnosis. 40% of patients presenting with DPLD will have no identifiable cause of DPLD after<br />
careful clinical evaluation. These patients are considered to have idiopathic DPLD, or termed idiopathic<br />
interstitial pneumonias.<br />
Abnormalities on the chest radiographs are usually the first clue to the presence of DPLD. Parenchymal<br />
infiltrates or nodules are typical finding on chest radiographs. HRCT are superior to chest radiographs and<br />
the pattern on HRCT can narrow the differential diagnosis and in some cases the HRCT is pathognomonic,<br />
obviating the need for lung biopsy.<br />
Pulmonary function test should be performed routinely in suspected DPLD to assess the extent of lung<br />
impairment. The pulmonary function test will show a restrictive pattern but will not establish a specific<br />
etiological diagnosis. Serological studies are rarely diagnostic but are indicated if connective tissue disease<br />
or hypersensitivity pneumonitis is suspected. Bronchoalveolar lavage (BAL) or transbronchial lung biopsy<br />
(TBLB) may be helpful to diagnose specific infections and may narrow the differential diagnosis.<br />
Surgical lung biopsy using the video assisted thoracoscopic surgical (VATS) technique should be performed<br />
in patients with DPLD when BAL or TBLB are not definitive. This will establish a definite diagnosis to guide the<br />
clinician to treat and manage the patient with DPLD.<br />
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