eMedicine Specialties > Pulmonology > Interstitial Lung Diseases

Restrictive Lung Disease: Multimedia

Author: Lalit K Kanaparthi, MD, Senior Fellow, Department of Pulmonary Medicine, Lenox Hill Hospital
Coauthor(s): Klaus-Dieter Lessnau, MD, FCCP, Clinical Associate Professor of Medicine, New York University School of Medicine; Medical Director, Pulmonary Physiology Laboratory; Director of Research in Pulmonary Medicine, Department of Medicine, Section of Pulmonary Medicine, Lenox Hill Hospital; Sat Sharma, MD, FRCPC, Professor and Head, Division of Pulmonary Medicine, Department of Internal Medicine, University of Manitoba; Site Director, Respiratory Medicine, St Boniface General Hospital
Contributor Information and Disclosures

Updated: Jul 27, 2009

Multimedia

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Media file 1: Approximately half of the patients with idiopathic pulmonary fibrosis develop clubbing. Clubbing is commonly seen in patients with asbestosis.

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Approximately half of the patients with idiopathic pulmonary fibrosis develop clubbing. Clubbing is commonly seen in patients with asbestosis.

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Media file 2: Lung volume is plotted against transpulmonary pressure. Compliance is the change in volume for a given change in pressure. A patient with emphysema has much higher lung compliance compared to a patient with intrinsic lung disease.

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Lung volume is plotted against transpulmonary pressure. Compliance is the change in volume for a given change in pressure. A patient with emphysema has much higher lung compliance compared to a patient with intrinsic lung disease.

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Media file 3: Idealized flow volume curves for normal, obstructive, and restrictive lungs.

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Idealized flow volume curves for normal, obstructive, and restrictive lungs.

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Media file 4: The expiratory flow volume curves of 2 patients are depicted graphically. A is a patient with restrictive lung disease (idiopathic pulmonary fibrosis), low forced vital capacity (FVC), but an increased ratio of forced expiratory volume in 1 second (FEV₁) to FVC because of increased elastic recoil. B is a patient with chronic obstructive lung disease whose FEV₁/FVC ratio is low but whose lung volumes are increased.

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The expiratory flow volume curves of 2 patients are depicted graphically. A is a patient with restrictive lung disease (idiopathic pulmonary fibrosis), low forced vital capacity (FVC), but an increased ratio of forced expiratory volume in 1 second (FEV₁) to FVC because of increased elastic recoil. B is a patient with chronic obstructive lung disease whose FEV₁/FVC ratio is low but whose lung volumes are increased.

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Media file 5: Pulmonary function test results from a patient with restrictive lung disease.

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Pulmonary function test results from a patient with restrictive lung disease.

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Media file 6: Gross pathology of small and firm lungs due to restrictive lung disease from advanced pulmonary fibrosis.

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Gross pathology of small and firm lungs due to restrictive lung disease from advanced pulmonary fibrosis.

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Media file 7: Intrinsic lung disease may progress to extensive fibrosis, regardless of etiology. This is described as honeycomb lung.

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Intrinsic lung disease may progress to extensive fibrosis, regardless of etiology. This is described as honeycomb lung.

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Media file 8: End-stage sarcoidosis.

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End-stage sarcoidosis.

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Media file 9: Usual interstitial pneumonitis (left).

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Usual interstitial pneumonitis (left).

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Media file 10: Usual interstitial pneumonitis (right).

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Usual interstitial pneumonitis (right).

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Media file 11: Histopathology of a case of idiopathic pulmonary fibrosis. Alveolitis with fibroblast proliferation and collagen deposition is present.

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Histopathology of a case of idiopathic pulmonary fibrosis. Alveolitis with fibroblast proliferation and collagen deposition is present.

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Media file 12: In usual interstitial pneumonitis or idiopathic pulmonary fibrosis, subpleural and paraseptal inflammation is present, with an appearance of temporal heterogeneity. Patchy scarring of the lung parenchyma and normal, or nearly normal, alveoli interspersed between fibrotic areas are the hallmarks of this disease. Additionally, the lung architecture is completely destroyed.

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In usual interstitial pneumonitis or idiopathic pulmonary fibrosis, subpleural and paraseptal inflammation is present, with an appearance of temporal heterogeneity. Patchy scarring of the lung parenchyma and normal, or nearly normal, alveoli interspersed between fibrotic areas are the hallmarks of this disease. Additionally, the lung architecture is completely destroyed.

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Media file 13: Characteristic features of usual interstitial pneumonitis as described in Media File 14.

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Characteristic features of usual interstitial pneumonitis as described in Media File 14.

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Media file 14: Bronchiolitis obliterans-organizing pneumonia (also called proliferative bronchiolitis) is often patchy and peribronchiolar. The proliferation of granulation tissue within small airways and alveolar ducts is excessive and is associated with chronic inflammation of surrounding alveoli.

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Bronchiolitis obliterans-organizing pneumonia (also called proliferative bronchiolitis) is often patchy and peribronchiolar. The proliferation of granulation tissue within small airways and alveolar ducts is excessive and is associated with chronic inflammation of surrounding alveoli.

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Media file 15: Bronchiolitis obliterans-organizing pneumonia, as described in Media File 16, showing a close-up view of fibrogranulation tissue in terminal airspaces.

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Bronchiolitis obliterans-organizing pneumonia, as described in Media File 16, showing a close-up view of fibrogranulation tissue in terminal airspaces.

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Media file 16: Granulomatous lung diseases are marked by granulomas characterized by the accumulation of T lymphocytes, macrophages, and epithelioid cells. These may progress to pulmonary fibrosis. This low-power image shows well-formed granuloma along the airway.

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Granulomatous lung diseases are marked by granulomas characterized by the accumulation of T lymphocytes, macrophages, and epithelioid cells. These may progress to pulmonary fibrosis. This low-power image shows well-formed granuloma along the airway.

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Media file 17: Multiple well-formed noncaseating granulomas secondary to sarcoidosis.

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Multiple well-formed noncaseating granulomas secondary to sarcoidosis.

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Media file 18: Sarcoid granulomas.

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Sarcoid granulomas.

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Media file 19: High-power view of sarcoid granuloma shows giant cells.

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High-power view of sarcoid granuloma shows giant cells.

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Media file 20: A patient who developed restrictive lung disease had findings of bronchiolitis obliterans-organizing pneumonia on an open lung biopsy specimen.

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A patient who developed restrictive lung disease had findings of bronchiolitis obliterans-organizing pneumonia on an open lung biopsy specimen.

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Media file 21: A patient who developed restrictive lung disease had findings of bronchiolitis obliterans-organizing pneumonia on an open lung biopsy specimen. The biopsy sample shows intraluminal buds of granulation tissue.

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A patient who developed restrictive lung disease had findings of bronchiolitis obliterans-organizing pneumonia on an open lung biopsy specimen. The biopsy sample shows intraluminal buds of granulation tissue.

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Media file 22: Lymphocytic interstitial pneumonitis, for which the prominent finding is a lymphoid infiltrate that involves both the interstitium and alveolar spaces.

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Lymphocytic interstitial pneumonitis, for which the prominent finding is a lymphoid infiltrate that involves both the interstitium and alveolar spaces.

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Media file 23: Usual interstitial pneumonitis honeycombing.

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Usual interstitial pneumonitis honeycombing.

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Media file 24: Chest radiograph of a 67-year-old man diagnosed with idiopathic pulmonary fibrosis, based on open lung biopsy findings. Extensive bilateral reticulonodular opacities are seen in both lower lobes.

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Chest radiograph of a 67-year-old man diagnosed with idiopathic pulmonary fibrosis, based on open lung biopsy findings. Extensive bilateral reticulonodular opacities are seen in both lower lobes.

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Media file 25: High-resolution CT scan of the same patient in Media File 26 demonstrates peripheral honeycombing and several areas of ground-glass attenuation. Ground-glass opacification may correlate with active alveolitis and a favorable response to therapy.

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High-resolution CT scan of the same patient in Media File 26 demonstrates peripheral honeycombing and several areas of ground-glass attenuation. Ground-glass opacification may correlate with active alveolitis and a favorable response to therapy.

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Media file 26: A CT scan image from a 59-year-old woman shows advanced pulmonary fibrosis. Extensive honeycombing and traction bronchiectasis are present.

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A CT scan image from a 59-year-old woman shows advanced pulmonary fibrosis. Extensive honeycombing and traction bronchiectasis are present.

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Media file 27: Restrictive lung disease may occur in stage II and stage III sarcoidosis. In this image, mediastinal lymphadenopathy is shown secondary to stage II disease.

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Restrictive lung disease may occur in stage II and stage III sarcoidosis. In this image, mediastinal lymphadenopathy is shown secondary to stage II disease.

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Media file 28: Sarcoidosis on CT scan shows nodules in midlung zones. These nodules are predominantly along the bronchovascular bundles and in a subpleural location.

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Sarcoidosis on CT scan shows nodules in midlung zones. These nodules are predominantly along the bronchovascular bundles and in a subpleural location.

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Media file 29: Restrictive lung disease secondary to sarcoidosis.

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Restrictive lung disease secondary to sarcoidosis.

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Media file 30: A chest radiograph of stage III sarcoidosis. This stage refers to pulmonary infiltrates without evidence of mediastinal lymphadenopathy.

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A chest radiograph of stage III sarcoidosis. This stage refers to pulmonary infiltrates without evidence of mediastinal lymphadenopathy.

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Media file 31: Chest radiograph from a 39-year-old woman with severe kyphoscoliosis who developed hypercapnic respiratory failure. Spirometry findings showed a severe restrictive lung disease, with a forced expiratory volume in one second of 0.4 L/s and a forced vital capacity of 0.5 L.

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Chest radiograph from a 39-year-old woman with severe kyphoscoliosis who developed hypercapnic respiratory failure. Spirometry findings showed a severe restrictive lung disease, with a forced expiratory volume in one second of 0.4 L/s and a forced vital capacity of 0.5 L.

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Media file 32: The flow volume curve of a patient with lung fibrosis.

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The flow volume curve of a patient with lung fibrosis.

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Media file 33: Likely case of idiopathic pulmonary fibrosis, which should be treated with prednisone.

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Likely case of idiopathic pulmonary fibrosis, which should be treated with prednisone.

More on Restrictive Lung Disease

Overview: Restrictive Lung Disease

Differential Diagnoses & Workup: Restrictive Lung Disease

Treatment & Medication: Restrictive Lung Disease

Follow-up: Restrictive Lung Disease

Multimedia: Restrictive Lung Disease

References

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References

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Douglas WW, Ryu JH, Swensen SJ, et al. Colchicine versus prednisone in the treatment of idiopathic pulmonary fibrosis. A randomized prospective study. Members of the Lung Study Group. Am J Respir Crit Care Med. Jul 1998;158(1):220-5. [Medline].
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Keywords

restrictive lung disease, pulmonary fibrosis, kyphoscoliosis, sarcoidosis, interstitial pneumonitis, intrinsic lung diseases, pneumonitis, diseases of lung parenchyma, interstitial lung disease, pneumonitis, idiopathic fibrotic diseases, connective-tissue diseases, drug-induced lung disease, primary lung disease, extrinsic lung disorders, extraparenchymal diseases, lung restriction, impaired ventilatory function, respiratory failure, idiopathic pulmonary fibrosis, IPF, total lung capacity, TLC

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Contributor Information and Disclosures

Author

Lalit K Kanaparthi, MD, Senior Fellow, Department of Pulmonary Medicine, Lenox Hill Hospital
Lalit K Kanaparthi, MD is a member of the following medical societies: American College of Chest Physicians, American Medical Association, and American Thoracic Society
Disclosure: Nothing to disclose.

Coauthor(s)

Klaus-Dieter Lessnau, MD, FCCP, Clinical Associate Professor of Medicine, New York University School of Medicine; Medical Director, Pulmonary Physiology Laboratory; Director of Research in Pulmonary Medicine, Department of Medicine, Section of Pulmonary Medicine, Lenox Hill Hospital
Klaus-Dieter Lessnau, MD, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Medical Association, American Society for Artificial Internal Organs, American Thoracic Society, Physicians for Social Responsibility, and Society of Critical Care Medicine
Disclosure: sepracor Ownership interest None

Sat Sharma, MD, FRCPC, Professor and Head, Division of Pulmonary Medicine, Department of Internal Medicine, University of Manitoba; Site Director, Respiratory Medicine, St Boniface General Hospital
Sat Sharma, MD, FRCPC is a member of the following medical societies: American Academy of Sleep Medicine, American College of Chest Physicians, American College of Physicians-American Society of Internal Medicine, American Thoracic Society, Canadian Medical Association, Royal College of Physicians and Surgeons of Canada, Royal Society of Medicine, Society of Critical Care Medicine, and World Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Laurie Robin Grier, MD, Medical Director of MICU, Associate Professor of Medicine, Section of Pulmonary and Critical Care Medicine, Louisiana State University Health Science Center at Shreveport
Laurie Robin Grier, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Society for Parenteral and Enteral Nutrition, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Daniel R Ouellette, MD, FCCP, Associate Professor of Medicine, Wayne State University School of Medicine; Consulting Staff, Pulmonary Disease and Critical Care Medicine Service, Henry Ford Health System
Daniel R Ouellette, MD, FCCP is a member of the following medical societies: American College of Chest Physicians and American Thoracic Society
Disclosure: Boehringer Ingleheim Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching

CME Editor

Timothy D Rice, MD, Associate Professor, Departments of Internal Medicine and Pediatrics and Adolescent Medicine, Saint Louis University School of Medicine
Timothy D Rice, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Physicians
Disclosure: Nothing to disclose.

Chief Editor

Zab Mosenifar, MD, Director, Division of Pulmonary and Critical Care Medicine, Director, Women's Guild Pulmonary Disease Institute, Executive Vice Chair, Department of Medicine, Cedars Sinai Medical Center; Professor of Medicine, David Geffen School of Medicine at UCLA
Zab Mosenifar, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, and American Thoracic Society
Disclosure: Nothing to disclose.

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eMedicine Specialties > Pulmonology > Interstitial Lung Diseases

Restrictive Lung Disease: Multimedia

Multimedia

Approximately half of the patients with idiopathic pulmonary fibrosis develop clubbing. Clubbing is commonly seen in patients with asbestosis.

Lung volume is plotted against transpulmonary pressure. Compliance is the change in volume for a given change in pressure. A patient with emphysema has much higher lung compliance compared to a patient with intrinsic lung disease.

Idealized flow volume curves for normal, obstructive, and restrictive lungs.

Pulmonary function test results from a patient with restrictive lung disease.

Gross pathology of small and firm lungs due to restrictive lung disease from advanced pulmonary fibrosis.

Intrinsic lung disease may progress to extensive fibrosis, regardless of etiology. This is described as honeycomb lung.

End-stage sarcoidosis.

Usual interstitial pneumonitis (left).

Usual interstitial pneumonitis (right).

Histopathology of a case of idiopathic pulmonary fibrosis. Alveolitis with fibroblast proliferation and collagen deposition is present.

Characteristic features of usual interstitial pneumonitis as described in Media File 14.

Bronchiolitis obliterans-organizing pneumonia (also called proliferative bronchiolitis) is often patchy and peribronchiolar. The proliferation of granulation tissue within small airways and alveolar ducts is excessive and is associated with chronic inflammation of surrounding alveoli.

Bronchiolitis obliterans-organizing pneumonia, as described in Media File 16, showing a close-up view of fibrogranulation tissue in terminal airspaces.

Granulomatous lung diseases are marked by granulomas characterized by the accumulation of T lymphocytes, macrophages, and epithelioid cells. These may progress to pulmonary fibrosis. This low-power image shows well-formed granuloma along the airway.

Multiple well-formed noncaseating granulomas secondary to sarcoidosis.

Sarcoid granulomas.

High-power view of sarcoid granuloma shows giant cells.

A patient who developed restrictive lung disease had findings of bronchiolitis obliterans-organizing pneumonia on an open lung biopsy specimen.

A patient who developed restrictive lung disease had findings of bronchiolitis obliterans-organizing pneumonia on an open lung biopsy specimen. The biopsy sample shows intraluminal buds of granulation tissue.

Lymphocytic interstitial pneumonitis, for which the prominent finding is a lymphoid infiltrate that involves both the interstitium and alveolar spaces.

Usual interstitial pneumonitis honeycombing.

Chest radiograph of a 67-year-old man diagnosed with idiopathic pulmonary fibrosis, based on open lung biopsy findings. Extensive bilateral reticulonodular opacities are seen in both lower lobes.

High-resolution CT scan of the same patient in Media File 26 demonstrates peripheral honeycombing and several areas of ground-glass attenuation. Ground-glass opacification may correlate with active alveolitis and a favorable response to therapy.

A CT scan image from a 59-year-old woman shows advanced pulmonary fibrosis. Extensive honeycombing and traction bronchiectasis are present.

Restrictive lung disease may occur in stage II and stage III sarcoidosis. In this image, mediastinal lymphadenopathy is shown secondary to stage II disease.

Sarcoidosis on CT scan shows nodules in midlung zones. These nodules are predominantly along the bronchovascular bundles and in a subpleural location.

Restrictive lung disease secondary to sarcoidosis.

A chest radiograph of stage III sarcoidosis. This stage refers to pulmonary infiltrates without evidence of mediastinal lymphadenopathy.

Chest radiograph from a 39-year-old woman with severe kyphoscoliosis who developed hypercapnic respiratory failure. Spirometry findings showed a severe restrictive lung disease, with a forced expiratory volume in one second of 0.4 L/s and a forced vital capacity of 0.5 L.

The flow volume curve of a patient with lung fibrosis.

Likely case of idiopathic pulmonary fibrosis, which should be treated with prednisone.

More on Restrictive Lung Disease

References

Further Reading

Keywords

Contributor Information and Disclosures

Author

Coauthor(s)

Medical Editor

Pharmacy Editor

Managing Editor

CME Editor

Chief Editor