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Pulmonary Fibrosis

Interstitial prominence on chest film

05/11/2007

Question:

I have a myopathy with proximal and resp. muscle weakness verified by emg/muscle bx and pft`s. I have a restrictive impairment on pft`s also with a decreased dlco (67%). On my chest film , it showed interstitial prominence and scattered granulomas. I had a HRCT that showed small amt of bibasilar interstitial changes . What does the interstitial prominence and granulomas mean? I have air hunger and dyspnea- worse with exertion. On a 6MW test, I did not desturate but did become tacycardic.On a stress echo, I did desaturate briefly but was very dyspneic which took a while to return to baseline. It showed poor exercise tolerance. I follow with my pulmonolgist q 6 mos with spirometry and dlco. Thanks for your help. Is there any other testing you recommend?

Answer:

Many forms of myopathy can cause interstitial lung disease. A common type of myopathy that does this is called polymyositis. Interstitial lung disease associated with polymyositis can result in shortness of breath and a low blood oxygen level.

Fortunately, these types of interstitial lung disease can often be treated with medications such as:

Sometimes additional tests such as bronchoscopy or lung biopsy are required in order to exclude other conditions that can cause interstitial changes on the x-ray (such as infection).

Another cause of shortness of breath (dyspnea) and a low diffusing capacity in polymyositis is pulmonary hypertension. Often, signs of pulmonary hypertension can be found on a cardiac echo. Pulmonary hypertension is treated with different drugs than interstitial lung disease.

Granulomas are benign scars on the lung, often due to previous infections by yeasts such as histoplasmosis.

For more information:

Go to the Pulmonary Fibrosis health topic, where you can:

Response by:

James N Allen, Jr, MD James N Allen, Jr, MD
Clinical Professor of Pulmonary, Allergy, Critical Care & Sleep Medicine
College of Medicine
The Ohio State University