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1、DermatomyositisandinterstitiallungdiseaseAsminTulpule,HMSIIINovember16,2009CoreRadiologyClerkshipAgenda?Presentationofourpatient?Menuofradiologictests?Basicsofinterstitiallungdisease(ILD)?RadiologicsurveyofILD?Applicationofradiologicfindingstoourpatient’sclinicalcourseOurpatient:
2、Initialreport?Ms.Lisa57yearoldFwitharecentdiagnosisofdermatomyositis(DM)andILDtransferredtoBIDMCforworseningdyspneaandhypoxiaoverthepast2-3days?InitialdiagnosisofDMtwomonthspriorbasedonmyalgias,Gottron’spapules,andheliotroperash.Confirmedbyskinbiopsy.Heliotroperash?Norespiratoryc
3、omplaintsatfirstandinitialCTscanatOSHshowedmildILD.Startedon40mgprednisone.http://www.jfponline.com/images/5502/5502JFP_FMGrandRounds-fig1.jpgNote:DMisanidiopathicinflammatorymyopathywithastrongassociationwithILD(30-40%)characterizedbypulmonaryfibrosis,aswellasapredispositiontode
4、velopingvisceralmalignancies(stomach,pancreas).Ourpatient:PastMedicalHx?Begandevelopingdyspneaonexertionafteramonth.ThoughttobeprogressingpulmonaryfibrosisassociatedwithDM.Receivingincreasingprednisone(upto60mgPOqday)andstartedonintermittentinfusionsofSolumedrol.Shewasalsotriedon
5、IVIGandazathioprineforILDassociatedwithDM.Herrespiratorystatusdidnotimprove.?ShewasNOTplacedonanyantibioticprophylaxis?Shereportsnightsweatsforthepasttwomonths.Shedeniesanyfevers,chills,orsymptomsofGIillness.?Nopriorhistoryofsmoking.Norecentinternationaltravelhistory.Ourpatient:I
6、nitialEvaluation?Onthefloor,shereportsanacute2-3dayworseningofrespiratorystatus.Sheisnolongerabletowalkmorethanafewstepswithoutdevelopingacuteshortnessofbreath.PhysicalExam:VitalSigns:Tc97.2BP117/79HR77RR24O2sat:93%on6Land70%FMGEN:Illappearing,speakinginfullsentencesbutappearsdys
7、pneicwithconversation,occasionallystoppingtocatchherbreathLungs:clearanteriorly.Posteriorfinecracklesmidandlowerlungfields.Nowheezesorrhonchi.Cardiac:RRR.Nom/r/g.ProminentS2Let’snowdiscussthemenuofradiologicteststhatcouldhelpaidusinthediagnosisandmanagementofourpatient.Agenda?Pre
8、sentationofourpatient?Menuofradiologicte
