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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.