Abbreviation Key ^
Clinical Differential:
Clinical Differential:
Clinical Differential:
Clinical Differential:
UIP Pattern
Clinical Differential:
YES
NO
LCH
DIP
IPF
CTD-ILD
HP
Smoking-Related ILD
Pneumoconiosis
Other Rare ILD
If unclassifiable or low diagnostic confidence, consider bronchoscopy
with lavage, cryobiopsy, or surgical biopsy for pathologic diagnosis.
Management by Disease Subtype
Integration of Clinical, Serological, and Radiographic Data
Is diagnostic confidence level >70%?
IPF
CTD-ILD
Exposure (eg, HP)
Phase 1
ILD Process Map
New Patient With Nonfocal Fibrosis on Chest CT Scan
History
Physiology Assessment
Physical Exam
History
Common Patterns
Phase 3
Phase 1
Phase 2
Baseline Evaluation
General Medicine
Pulmonary Evaluation
Multidisciplinary
Discussion
Pulmonary Function Test
6-Minute Walk Test
Crackles
Joint Deformities
Rashes or Skin Thickening
Weakness
RB-ILD
Less Common Patterns
Radiology Review - Identify High-Resolution CT Scan Pattern to Construct Clinical Differential
Clinical Differential:
NSIP Pattern
CTD-ILD
HP
Drug Toxicity
Idiopathic NSIP
HP Pattern
Nonfibrotic HP
Fibrotic HP
LIP Pattern
CTD-ILD
HIV
Immunodeficiences
DIP Pattern
Smoking
Toxic fumes
Idiopathic DIP
CTD-ILD
HIV
Cystic Lung Disease
LAM
LCH
LIP
Birt-Hogg-Dube
Phase 2
PULMONARY
EVALUATION
Family History
If symptoms or radiographic
patterns are suggestive of
underlying CTD, send autoimmune serologies and refer the patient to
rheumatology.
Cough
Shortness of Breath
Symptoms of Underlying CTD
(eg, dry eyes, dry mouth, dysphagia, myalgia, arthralgia, rashes, Raynaud's syndrome)