Correlation of HRCT with PFT and Broncho Alveolar Lavage in Interstitial Lung Diseases of Collagen Vascular Disorders

Mahesh Kumar, A (2006) Correlation of HRCT with PFT and Broncho Alveolar Lavage in Interstitial Lung Diseases of Collagen Vascular Disorders. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION : Interstitial lung diseases is a term given to a heterogeneous group of clinical entities that share the following features: dyspnea, hypoxemia, restrictive ventilatory defect and the presence of bilateral diffuse pulmonary infiltrates on the chest roentgenograms. It is now recently called by the term Diffuse Parenchymal lung diseases (DPLD) which is now on an increase. The reason for that is the increased awareness, thorough history evaluation and the lot of incoming trials in the field of investigating modality. The disease is characterized by deteriorating parenchymal fibrosis and gas exchange. It remains innocuous in the early stage as most of the rheumatic patients have restricted mobility manifesting with subtle or nil pulmonary symptoms. Hence respiratory physician should be prudential in diagnosing the cases as early as possible. This study throws light on the semi invasive procedures on clinically and radiologically diagnosed cases rather than the invasive procedures. Since most of the patients denies procedures like surgical or transbronchial lung biopsies as well as they are in real respiratory compromise, it is better to opt an alternative procedure. Bronchoalveolar lavage and pulmonary function test are frequently done nowadays as an adjunct to aid the diagnosis. The extent and pattern of the lesion in the High resolution computerized tomography is described in detail and its severity is identified based on the correlation with PFT (Pulmonary function tests) and cellularity of the Bronchoalveolar lavage fluid. To enhance the knowledge in this area, statistical analysis is performed. This highlights the agreement as well as discordance between the variables. AIM OF THE STUDY : To quantify the extent and severity of the interstitial lung disease as depicted in High Resolution computerized tomography. To study the relationship between the radiological patterns of Interstitial lung diseases with functional parameter (Forced vital capacity) and the cellularity of bronchoalveolar lavage fluid in patients with collagen vascular diseases. MATERIALS AND METHODS : The study was organized in the Institute of Thoracic Medicine (I.T.M) and Department of Thoracic Medicine in association with Rheumatology Department, Madras Medical College. The design of the work is a prospective case study. It extends from the period of January 2005 to November 2005 and it is performed at the Department of Thoracic Medicine with source population from the Department of Rheumatology-Madras Medical College-Chennai. INCLUSION CRITERIA : 1. Serologically positive collagen vascular disorder patients. 2. Clinically and radiologically confirmed cases of Interstitial Lung Diseases (ILD). EXCLUSION CRITERIA : 1. Patient associated with co-morbid illness like congestive cardiac failure, tuberculosis and malignancy. 2. Smokers are virtually eliminated from the study since it is a confounding factor for (e:g) the respiratory bronchiolitis of smoking can be falsely attributed to collagen vascular disorders. 3. ILD’s due to other etiologies, Granulamatous diseases, Environmental & occupational, Iatrogenic & drug induced, Idiopathic interstitial pneumonia, Unique entities, Inherited. 4. ILD mimickers. CONCLUSION : Majority of the cases (91%) were presented with the reticular pattern compared to the Ground Glass Opacity. Both High resolution computerized tomography patterns (Reticular and Ground glass opacity) have reduced vital capacity but the severity of reduction is more in reticular pattern than that of the Ground Glass Opacity. Of the reticular pattern inter / intralobar septal thickening is more frequent than either honey combing or sub pleural thickening. The presence of Reticular pattern in High resolution computerized tomography has a very good correlation with reduced Forced vital capacity of the Pulmonary function test. From the cross tabulation listed above and analyzing the Reticular pattern of high resolution computerized tomography with neutrophilic cellularity of Bronchoalveolar lavage, it is inferred from the values that there is a perfect agreement between these both. Similarly the Ground Glass Opacity pattern has positive correlation with lymphocytic cellularity of Bronchoalveolar lavage. So High Resolution Computerised Tomography is a sensitive tool in identifying pattern and profusion of the lesion. The severity of the lesion is identified by correlating High Resolution Computerised Tomography, pulmonary function and Bronchoalveolar lavage.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Correlation ; HRCT ; PFT ; Broncho Alveolar Lavage ; Interstitial Lung Diseases ; Collagen Vascular Disorders.
Subjects: MEDICAL > Tuberculosis and Respiratory Medicine
Depositing User: Subramani R
Date Deposited: 29 Jun 2017 12:13
Last Modified: 28 Feb 2018 15:47

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