You are called to attend to an ER patient complaining of shortness of breath and severe dyspnea on exertion

Question

Patient history is significant for a 30-year-pack smoking history, dry nonproductive cough, and occasional pedal edema. CXR findings are not remarkable except for mild cardiomegaly. You want to rule out ILD versus obstructive lung disease. Which of the following tests may help you to differentiate the diagnosis on this patient?
1. Sputum culture and sensitivity
2. High-resolution CT
3. Pulmonary function testing
4. Arterial blood gas analysis
a. 2, 3, and 4 only
b. 1, 3, and 4 only
c. 1 and 4 only
d. 3 and 4 only

Answer 1

ANS: A
Obtaining HRCT images allows noninvasive evaluation of the ILDs and is a key element in making a confident diagnosis in the management of ILD. An ABG is useful to assess gas ex-change. The presence of significant mismatching, shunt, and decreased diffusion across the abnormal interstitium is a hallmark of IDLs. Both FEV1 and FVC are diminished, and the FEV1/FVC ratio is preserved or even supranormal. Lung volumes are reduced, as is the diffusing capacity of the lung for carbon monoxide (DLCO). This reduction in diffusing capacity reflects a pathological disturbance of the alveolus-capillary interface.