EpistemisBilateral symmetrical apical Velcro-type crackles
Specialty: Respiratory.
Why it occurs
- Sarcoidosis in advanced fibrosing stage (symmetrical preferential involvement of the upper lobes with honeycombing and apical hilar retraction that manifests auscultatory with fine dry crackles in the upper areas of both lungs)
- Sequel bilateral cavitary and fibrotic pulmonary tuberculosis located in the lung apices
- Complicated silicosis in the phase of progressive massive fibrosis with apical predominance
- Chronic hypersensitivity pneumonitis in stages where inhaled antigenic exposure has caused predominantly bilateral apical inflammation and scarring.
Initial workup
High-resolution chest computed tomography (CT) (HRCT) without contrast; Forced spirometry and diffusing capacity for carbon monoxide (DLCO); Serial sputum smear microscopy and culture; Analysis with elevated serum ACE (angiotensin-converting enzyme) if active sarcoidosis is suspected.
red flags
Productive cough with abundant hemoptoic sputum or frank hemoptysis, progressive dyspnea on exertion that limits daily activities, low fever predominantly in the afternoon with night sweats, or marked involuntary weight loss.
Standard management
- Management is fundamentally etiological
- Prednisone — 20-40 mg orally daily if there is active inflammatory pulmonary sarcoidosis requiring immune suppression
- Nintedanib — 150 mg every 12 hours in case of progressive fibrosing progression
- Conventional anti-tuberculosis treatment if a positive smear test is confirmed.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Respiratory
- Listed causes
- 4
- Treatment options
- 4