AM Report Pearls: Hypersensitivity Pneumonitis
- Hypersensitivity pneumonitis (HP) is also called extrinsic allergic alveolitis – chronic granulomatous inflammation in response to repeated inhalation of environmental antigens
- Take a detailed occupational/exposure history – birds, pets, hot tub, saunas, mold, down comforters, etc.
- Three main timecourses/forms that you see:
- Acute: Occurs after intermittent heavy exposure to antigen – you can have fevers, chills, malaise, dyspnea, chest tightness & cough ~4-8 hrs post-exposure, can resolve within 48 hrs
- Subacute: Episodic attacks/flares that resemble acute HP with chronic low-level antigen exposure
- Chronic: Often no history of acute episodes, chronic progressive dyspnea, cough, fatigue over months
- High-res Chest CT can show a variety of findings that can mimic IPF – GGOs, mosaic perfusion with air-trapping, diffuse reticular opacities, micronodules, loss of lung volume, honeycombing
- For more information of the “head cheese sign”, check out Radiopaedia here: http://radiopaedia.org/articles/head-cheese-sign
- Refer to a certified industrial hygienist to help go into the patient’s home to remove offending antigen
- Great 2-page review of HP by UCSF faculty here: https://www.calthoracic.org/sites/default/files/eventhp.pdf
AM Report Pearls: Arrhythmogenic Right Ventricular Dysplasia
- ARVD is a hereditary condition w progressive fibrofatty replacement of cardiac myocytes in the RV>LV. Prevalence is 1:1000-5000 in the general pop. but up to 25% in cases of sudden cardiac death < 30yo
- Presentation – age teens-30s w/ palpitations, syncope, lightheadedness, ventricular arrhythmias or sudden cardiac death. Symptoms may precede apparent structural disease.
- Diagnosis – based on having 2 major, 1 major + 2 minor, or 4 minor Task Force Criteria. See attached article for criteria details. Can also test for known genetic mutations.
- Treatment – ICD placement in pts with VT/VF, high PVC burden, or symptoms of ARVD.