Diagnostic Criteria for Idiopathic Pulmonary Fibrosis (IPF)

In 2000, IPF was defined as a specific form of chronic, progressive, fibrosing interstitial pneumonia of unknown cause, occurring primarily in older adults and limited to the lungs. Usual interstitial pneumonia (UIP) is the histopathological pattern of IPF. IPF is characterized by progressive worsening of dyspnea and lung function and is associated with a poor prognosis. Continue reading

Wells Clinical Prediction Rule for Pulmonary Embolism and Deep Venous Thrombosis

Wells Clinical Prediction Rule for Pulmonary Embolism (PE) Continue reading

ATS/ERS Criteria for Diagnosis of Idiopathic Pulmonary Fibrosis (IPF) in Absence of Surgical Lung Biopsy

Major Criteria

  1. Exclusion of other known causes of ILD such as certain drug toxicities, environmental exposures, and connective tissue diseases

  2. Abnormal pulmonary function studies that include evidence of restriction (reduced VC, often with an increased FEV1/FVC ratio) and impaired gas exchange [increased P(A–a)O2, decreased PaO2 with rest or exercise or decreased DLCO]

  3. Bibasilar reticular abnormalities with minimal ground glass opacities on HRCT scans

  4. Transbronchial lung biopsy or BAL showing no features to support an alternative diagnosis

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GOLD Staging System for Chronic Obstructive Lung Disease (COPD) Severity

The European Respiratory Society (ERS) diagnostic criteria for COPD include the following symptoms: coughing, sputum production and/or dyspnoea, as well as a history of exposure to risk factors for COPD. The diagnosis is confirmed by a post-bronchodilator FEV1/FVC < 0.7 in spirometry, as sign of the airflow limitation that is not fully reversible.

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Indications for Lung Biopsy

Patients with lesions on the chest radiograph should be discussed in a multidisciplinary meeting with a respiratory physician and radiologist at a minimum.

Percutaneous transthoracic lung biopsy (PTLB) should be considered in the following:

  • New or enlarging solitary nodule or mass on the chest radiograph which is not amenable to diagnosis by bronchoscopy or CT shows it is unlikely to be accessible by bronchoscopy.
  • Multiple nodules in a patient not known to have malignancy or who has had a prolonged remission or more than one primary malignancy.
  • Persistent focal infiltrates, either single or multiple, for which no diagnosis has been made by sputum or blood culture, serology, or bronchoscopy.
  • Hilar mass following negative bronchoscopy. Continue reading

Diagnostic Criteria for Amiodarone-Induced Pulmonary Toxicity (APT)

The clinical diagnosis of amiodarone-induced pulmonary toxicity (APT) requires two or more of the following criteria:

  1. new onset of pulmonary symptoms such as dyspnea, cough, or pleuritic chest pain;
  2. new chest radiographic abnormality such as an interstitial or alveolar infiltrate;
  3. a decrease in the DLCO of 20% from the pretreatment value, or if none is available, a value less than 80% of predicted;
  4. abnormal lung uptake with gallium-67 radioisotope; and
  5. characteristic histologic changes of lung tissue obtained by bronchoscopic or open lung biopsy.

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