Lung fibrosis

Lung fibrosis

It is important in the exam to be able to differentiate between conditions causing predominately upper or lower zone fibrosis. It should be noted that the more common causes (idiopathic pulmonary fibrosis, drugs) tend to affect the lower zones

Fibrosis predominately affecting the upper zones

• hypersensitivity pneumonitis
  Upper zones lung fibrosis: hypersensitivity pneumonitis
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  Importance: 42
  (also known as extrinsic allergic alveolitis)
• coal worker's pneumoconiosis
  Upper zones lung fibrosis: coal worker's pneumoconiosis
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  Importance: 11
  /progressive massive fibrosis
• silicosis
  Upper zones lung fibrosis: silicosis
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  Importance: 40
• sarcoidosis
  Upper zones lung fibrosis: sarcoidosis
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  Importance: 31
• ankylosing spondylitis
  Upper zones lung fibrosis: ankylosing spondylitis
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  Importance: 29
  (rare)
• histiocytosis
  Upper zones lung fibrosis: histiocytosis
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  Importance: 43
• tuberculosis
  Tuberculosis typically causes upper zone pulmonary fibrosis
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  Importance: 24
• radiation-induced pulmonary fibrosis
  radiation-induced pulmonary fibrosis
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  • may develop following radiotherapy for breast or lung cancer
  • typically seen between 6 and 12 months following completion of radiotherapy course

Fibrosis predominately affecting the lower zones

• idiopathic pulmonary fibrosis
  Idiopathic pulmonary fibrosis predominately affects the lower zones
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  Importance: 58
• most connective tissue disorders (except ankylosing spondylitis) e.g. SLE
  Lower zones lung fibrosis: SLE
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  Importance: 31
• drug-induced: amiodarone
  Lower zones lung fibrosis: amiodarone
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  Importance: 58
  , bleomycin
  Lower zones lung fibrosis: bleomycin
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  Importance: 26
  , methotrexate
  Lower zones lung fibrosis: methotrexate
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  Importance: 35
• asbestosis
  Asbestosis causes pulmonary fibrosis predominantly affecting the lower zones
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  Importance: 46

+PassMedicine Notes

It is important in the exam to be able to differentiate between conditions causing predominately upper or lower zone fibrosis. It should be noted that the more common causes (idiopathic pulmonary fibrosis, drugs) tend to affect the lower zones

Fibrosis predominately affecting the upper zones

• hypersensitivity pneumonitis (also known as extrinsic allergic alveolitis)
• coal worker's pneumoconiosis/progressive massive fibrosis
• silicosis
• sarcoidosis
• ankylosing spondylitis (rare)
• histiocytosis
• tuberculosis
• radiation-induced pulmonary fibrosis
• may develop following radiotherapy for breast or lung cancer
• typically seen between 6 and 12 months following completion of radiotherapy course

Fibrosis predominately affecting the lower zones

• idiopathic pulmonary fibrosis
• most connective tissue disorders (except ankylosing spondylitis) e.g. SLE
• drug-induced: amiodarone, bleomycin, methotrexate
• asbestosis

Acronym for causes of upper zone fibrosis:

CHARTS

• C - Coal worker's pneumoconiosis
• H - Histiocytosis/ hypersensitivity pneumonitis
• A - Ankylosing spondylitis
• R - Radiation
• T - Tuberculosis
• S - Silicosis/sarcoidosis