The Clinical Analysis Of Etiology Of Diffuse Pulmonary Infiltrates

Objective： To study and summarize the cause constitution, clinicaland chest image features, as well as the key points of diagnosis anddifferential diagnosis of diffuse pulmonary infiltrates (DPI). so as toimprove the clinician’s understanding of the DPI and the level of diagnosisand treatment.Methods：The clinical data，including history, physical signs, chestimages, laboratory tests and lung biopsy pathological examinations， of82cases with DPI in our hospital from Mar2010to Jul2011were analyzedand summarized Prospectively.Results：Lung infectious disease, idiopathic interstitial pneumonia(IIP)，connective tissue disease (CTD)，were the main causes of82DPIpatients，they account for30cases(36.6%),17cases (20.7%),9cases (11%)respectively, the other causes included lung cancer, vasculitis，pulmonaryedema，sarcoidosis，pulmonary alveolar proteinosis，lymphoma, etc. Theyaccount for6cases (7.3%),4cases (4.9%),4cases (4.9%),3cases (3.7%),2cases (2.4%),1cases (1.2%) respectively.65（80%）out of82cases hadcough and progressive dyspnea,42（51.2%) cases had fever，31(37.8%) cases had moist rales and21(25.6%) had Velcro rales. The main chest CTexpressions were Ground-glass shadow，grid shadow, honeycomb change，nodules，opacities shadow，and so on.20cases（24.4%）out of82casesunderwent lung biopsy，16cases (80%) obtained pathological verification.10cases (12.2%) were cured,61cases (74.4%) improved,6patients (7.3%)died, and five cases (6.1%) discharged.Conclusion：（1）The etiology of DPI is complex, the82DPI cases in our studyincluded25kinds of causes, in which infectious diseases andnon-infectious diseases including IIP, CTD, etc, were more common.（2）Fever, Velcro rales, whether existing a special history or lowimmunity,etc,were important clinical features or clues in the differentialdiagnosis of DPI.（3）The HRCT is an important approach to guide the cause diagnosisof DPI. Different diseases showed different imaging features, such asGround-glass opacities, grid shadow, honeycombing, nodules, etc. Byanalysis and summary of these features, the accuracy and efficiency of thecause diagnosis of DPI can be improved significantly.（4）The histopathology and pathologic examination of lung biopsytissue are etiological verification approach of DPI, but only a minority ofpatients can undergo or need lung biopsy, while most patients can’tundergo or not need lung biopsy. In order to identify the cause and improve the prognosis of the DPI patients as soon as possible, it is essential tograsp the clinical, imaging features and construct a clear, reasonablediagnostic idea.（5）Most patients can get a better therapeutic effect with targetedtherapy after identifying the causes of DPI.