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Table 3 Clues from the physical examination and their disease associations

From: Diagnosis and management of interstitial lung disease

Organ system Finding Associated ILD or its complications
Lung Velcro crackles IPF, asbestosis > > other
Squeaks HP, bronchiolitis
Pleural rub RA, SLE
Skin Erythema nodosum Sarcoidosis, CTD, Behçet’s disease
Maculopapular rash CVD, drugs, sarcoidosis, amyloid
Heliotrope rash DM-PM
Gottron’s papules DM-PM
Café-au-lait spots Neurofibromatosis
Albinism HPS
Telangiectasia Scleroderma
Calcinosis Scleroderma, DM-PM
Subcutaneous nodules RA, neurofibromatosis, vasculitis
Cutaneous vasculitis PAG, RA, MPA, SLE, drug reaction
Mechanic’s hands DM-PM
Tight skin/ulcerations over digits Scleroderma
Eyes Uveitis Sarcoidosis, Behçet’s disease, AS
Scleritis SLE, scleroderma, sarcoidosis, PAG
Keratoconjunctivitis sicca Sjögren’s disease, CTD
Lacrimal gland enlargement Sarcoidosis
Horizontal nystagmus HPS
Salivary glands Enlarged Sjögren’s disease, sarcoidosis
Lymphatic Lymphadenopathy Sarcoidosis, lymphangitic CA, lymphoma
Reticuloendothelial Hepatosplenomegaly Sarcoidosis, LIP, CTD, EG, amyloid, lymphoma
Musculoskeletal Muscle weakness, myositis CTD (especially DM-PM), sarcoidosis
Synovitis, arthritis CTD, sarcoidosis
Nervous system Neurologic dysfunction Sarcoidosis, lymphangitic CA, NF, TS, CTD, PAG, MPA
Cardiovascular Systemic hypertension CTD, GPS, PAG, MPA, NF
Prominent P2 Suggests secondary PH (IPF, CTD, end stage sarcoidosis)
Pericardial rub Sarcoidosis, SLE
Extremities Digital clubbing IPF, asbestosis > chronic HP, DIP > other fibrotic ILD
Raynaud’s phenomenon CTD
  1. AS = ankylosing spondylitis; CA = cancer; CTD = connective tissue disease; DAH = diffuse alveolar hemorrhage; DM-PM = dermatopolymyositis; GPS = Goodpasture’s syndrome; HP = hypersensitivity pneumonitis; HPS = Hermansky-Pudlak syndrome; LAM = lymphangioleiomyomatosis; LCH = Langerhans cell histiocytosis; LIP = lymphoid interstitial pneumonia; MPA = microscopic polyangiitis; NF = neurofibromatosis; P2 = auscultated pulmonic valve closure sound; PAG = polyangiitis with granulomatosis; PH = pulmonary hypertension; RA = rheumatoid arthritis; SLE = systemic lupus erythematosus; TS = tuberous sclerosis.
  2. Reprinted with permission from Interstitial Lung Disease: A Practical Approach. Meyer KC, Raghu G: Patient evaluation. Second Edition, New York: Springer; 2011:3–16.