Internal illnesses. Fibrous alveolitis (lecture notes)

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Internal illnesses. Fibrous alveolitis (lecture notes)

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LECTURE No. 34. Fibrous alveolitis

Fibrous alveolitis is characterized by widespread fibrosis of the lungs below the level of the terminal bronchi (respiratory bronchioles and alveoli), leading to the development of an alveolar-capillary block and a sharp decrease in the diffusion capacity of the lungs, manifested by increasing pulmonary insufficiency.

The disease is relatively rare, equally common in men and women, in young and middle age.

Etiology. The etiology of the disease remains unknown. Inheritance is dominant.

Pathogenesis. Interstitial edema and inflammation develop, an irreversible stage of fibrosis is formed, and progressive respiratory failure develops.

Clinic. In the acute form, manifestations of an acute respiratory infection or pneumonia are characteristic, in the chronic form - progressive shortness of breath, unproductive or dry cough, fever to subfebrile (febrile), weakness, fatigue. The severity of shortness of breath and meager physical manifestations do not correspond to each other. Cyanosis, tachypnea, weight loss, change in the terminal phalanges of the fingers (drum sticks, watch glasses) are noted. Percussion is determined by the shortening of the lung sound, especially over the lower sections. Gentle crepitant rales, expressed in the basal regions, tachycardia, accent of the II tone over the pulmonary artery, in the later stages - signs of chronic cor pulmonale are auscultated.

Additional diagnostic study. A complete blood count (moderate leukocytosis, leukopenia, increased ESR, signs of anemia), a biochemical blood test (dysproteinemia, hypergammaglobulinemia), an immunological blood test (an increase in immunoglobulins of classes G and M, the appearance of antinuclear antibodies), an x-ray examination (strengthening and deformation of the lung pattern) are carried out. , its loopiness, nodular focal shadows, a possible decrease in the transparency of the lung tissue), a functional study of the lungs (the presence of a restrictive nature of respiratory disorders), a study of blood gases (a decrease in diffusion capacity).

Complications. Chronic cor pulmonale is the main complication of the disease.

Differential diagnostics. Should be carried out with pulmonary insufficiency, pulmonary heart failure.

Treatment. Shown are corticosteroids (early onset, long-term), a combination of corticosteroids with immunosuppressants. It is possible to use afferent methods (hemosorption, plasmapheresis). During the period of remission, the use of drugs of the aminoquinol series (delagil) is indicated.

Flow. The course of the disease is relapsing and progressive.

Forecast. Unfavorable, average life expectancy 3-5 years.

Author: Myshkina A.A.

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