0:00

Another patient with mild fibrosis here

0:03

and this is pretty mild, so peripheral bas

0:06

or predominant, I don't think I see any traction

0:09

bronchiectasis or bronchiectasis,

0:11

at least not with high confidence.

0:13

And so this is just mild peripheral

0:15

and basler reticular abnormality

0:18

and so I don't know what's going on.

0:20

I just wouldn't feel confident conice one way or another.

0:23

We can obviously look at the soft tissue windows

0:26

for other abnormalities.

0:27

So those are guys with Hawkeye.

0:29

You guys probably notice that the esophagus is dilated.

0:31

So we're gonna do a, a deep dive.

0:33

We're gonna look at the serologies

0:34

or at least our ask our pulmonologist rheumatologist

0:37

to look at serologies to assess for connect disease.

0:41

And we're gonna do a detailed history

0:43

and physical to look for signs

0:45

and symptoms of connect disease,

0:47

but based purely on imaging.

0:48

This is a hard pattern because it's so mild.

0:50

So what do you do with this? This is one

0:52

where I would probably call it just indetermined if UIP,

0:55

but I probably, I would bring the patient back in a year.

0:57

'cause this is so other people might just call this,

0:59

well this is interstitial lung abnormality.

1:02

I know I haven't really, we haven't really

1:03

talked about that in detail.

1:04

But bottom line, interstitial lung abnormality

1:06

and indetermined, if UIP are

1:09

somewhat related in determine if UIP is sort

1:11

of just throwing for hands saying

1:12

I don't know what's going on.

1:13

And that could be either, because again,

1:15

the disease is very mild like this

1:17

or it can be in cases where the pattern is just very complex

1:19

or confusing In ILA interstitial lung abnormality,

1:23

these are cases where you have very mild peripheral

1:26

reticulation with

1:27

or without con competent pulmonary fibrosis

1:29

where you're not sure if it's static scarring.

1:32

So like maybe the patient had a severe pneumonia,

1:34

severe aspiration, which cause a reticular abnormality

1:37

or it's early progressive pulmonary fibrosis

1:40

or early UIP idiopathic pulmonary fibrosis.

1:43

So that's, that's sort of the dichos decision point.

1:46

So is this gonna be just scarring, which is static

1:48

or a pulmonary fibrosis, which can get worse.

1:51

And so we call that interstitial lung abnormality.

1:54

We'll talk about this phenomenon, uh, few lectures from now.

1:58

But for this case, uh, in the schema

2:02

of a UIP diagnostic approach,

2:04

we're gonna call this indeterminate for UIP.

2:06

And again, I would bring this patient back in a year

2:08

'cause we would do the same thing for patients

2:09

with interstitial lung abnormality in addition

2:12

to correlating with longitudinal pulmonary function testing.