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“Futile and insensitive, I’m capable of violent and consuming impulses—both good and bad, noble and vile—but never of a sentiment that endures, never of an emotion that continues, entering into the substance of my soul. Everything in me tends to go on to become something else. My soul is impatient with itself, as with a bothersome child; its restlessness keeps growing and is forever the same. Everything interests me, but nothing holds me. I attend to everything, dreaming all the while.”

—Fernando Pessoa, The Book of Disquiet

Approach to Interstitial Lung Disease

  1. Pattern - nodular, reticular, septal lines, cystic
  2. Acute vs Chronic
  3. Clues - distribution, lung volumes, associated findings

Lung volumes

  • low - fibrosis
  • increased - obstruction

Nodular - Acute

  • Atypical - miliary TB, disseminated fungal

Nodular - Chronic

  • Mets, sarcoid, silicosis, EG, hypersensitivity

Nodular - Clues

  • Diffuse/Lower distribution - hematogenous (miliary or mets)
  • Upper lobe - sarcoid (assoc with adenopathy which can calcify), silicosis (calcified LN and NODULES), EG (central lucencies in nodules), hypersensitivity-subacute

—————————-

Reticular - Acute

  • interstitial edema
  • atypical (pneumocystitis or viral)

Reticular - Chronic

  • fibrosis
  • Not reticular but can look like it (emphysema, cystic lung dz, bronchiectasis)

Reticular - Clues

  • Normal lung volumes - acute - edema/infection; bronchiectasis
  • Increased lung volumes - cystic lung dz, emphysema, bronchiectasis
  • Decreased lung volumes - fibrosis

—————————-

FIBROSIS

  • upper lobe (CASSETE P) - sarcoid, silicosis (perihilar masses well defined c/w sarcoid), chronic hypersensitivity, CF, XRT, TB, ank spond
  • lower lobe (BADAS)- UIP, NSIP, chronic aspiration

—————————-

Septal Lines - Acute

  • edema
  • atypical infections

Septal Lines - Chronic

  • lymphangitic ca (organs seen on cxr - ie lungs, gastric, breast, pancreas), amyloid, kaposi

—————————-

Cysts/Ring Lucencies - Acute

  • PCP, necrotizing pneumonia

Cysts/Ring Lucencies - Chronic

  • honeycombing, bronchiectasis, EG, LAM, emphysema

Cysts - Clues

  • Upper lobe - PCP, EG, CF, honeycombing - sarcoid, chronic hypersensitivity
  • Lower lobe - honeycombing - UIP, alpha 1 antitrypsin, bronchiectasis (cysts upon cysts) -aspiration
  • No lobar distribution - LAM

—————————-

Septal Lines + Nodules

  • Acute - atypical infections
  • Chronic - lymphangitic ca

Source = Thoracic Imaging - Pulmonary and Cardiovascular Radiology, Webb

    Endreal's brief list of words that sound exactly like what they mean

    …and are also just super-fun to say! To me, at least.

    • interstitial
    • copacetic
    • tatterdemalion

    What other words should be added to the list?

    The illegal, interstitial art of yarnbombing

    interstitialarts.org

    My second Interstitial Arts Foundation article is up! I tried to explain the urge to go out and cover innocent lampposts with knitting. 

    Key factors in pathogenesis pain and voiding dysfunctions?

    • Histamine and TNF-alpha in bladder wall, secreted by activated mast cells!

    Meet the IAF: Emily Wagner

    interstitialarts.org

    Um. Sorry if you’ve seen this when I posted it other places. It seems like a thing I should post ‘cause it’s about me and stuff I do.

    Silent Lucidity (Queensryche cover)

    Interstitial

    I’m smiling next to you…

    Interstitial’s electronic cover of Queensryche’s “Silent Lucidity.”

    Silent Lucidity (Queensryche cover)

    Interstitial

    “Or has it just begun?”

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