Benign Lung Conditions III

Author: Shelby Stewart, MD
Institution: University of Maryland
Date Reviewed: 2024
Original Case: Stephen C. Yang, MD
Learning Domain: General Thoracic
Learning Objective: Pneumonia, pulmonary sequestration
PowerPoint File: Benign Lung Conditions III

 

Learning Goals

  • The basic level concepts focused on:
    • Knowledge of Parasitic Disease
    • Work up and patient care for hemoptysis
    • Knowledge of Interstitial Lung Disease
  • The advanced level concepts focused on:
    • Patient Care of Parasitic Disease
    • Patient Care of Interstitial Lung Disease

 

Case #1 Discussion Points for Conference

  • Next diagnostic steps?
    • Bronchoscopy with transbronchial biopsy
    • Fine needle aspiration
  • Management of hemoptysis?
    • Angiography and possible embolization
    • Bronchoscopy
      • Balloon occlusion
      • Topical medications/ Iced Lavage
      • Ablative/cryotherapies
    • Lateral decubitus positioning 
    • Mainstem intubation
  • Differential diagnosis?
    • Malignancy
    • Infectious etiology
    • Inflammatory disease
    • Vascular anomaly
  • Medical management?
    • Intubation
    • Hemodynamic Management
  • Indications for surgery?
    • Life threatening bleeding (rare)
    • Refractory bleeding
  • Surgical approaches?
    • Thoracotomy vs thoracoscopic
    • Lobectomy, sublobar resection  

 

Case #2 Discussion Points for Conference

  • Differential diagnosis?
    • Interstitial lung disease: Usual Interstitial Pneumonia (UIP), Non-Specific Interstitial Pneumonia (NSIP), Chronic Hypersensitivity Pneumonitis (CHP), Pulmonary sarcoid 
  • Next diagnostic steps?
    • Bronchoscopy with transbronchial biopsy and BAL
    • Lung biopsy
  • Medical treatment?
    • Steroids
    • Novel therapies
    • Lung transplantation
  • Indications for surgery?
  • Surgical approaches?  
  • Unable to tolerate single lung ventilation?
  • Sputum:  respiratory flora
  • Bronchoscopy negative

 

Learning Points

  • Initial stabilization of hemoptysis
  • Work up and treatment of hemoptysis
  • Treatment of parasitic organisms
  • Indications for lung biopsy for interstitial lung diseases
  • Different types of ILD:  prognosis and management