EpistemisSingle left basal velcro-type crackles
Specialty: Respiratory.
Why it occurs
- Localized pulmonary fibrosis secondary to severe organizing bacterial pneumonia or chronic empyema in the left lower lobe (replacement of alveoli by dense restrictive scar tissue that opens loudly on inspiration)
- Left pulmonary infarction organized by previous thromboembolism with local structural sequelae
- Early asymmetric interstitial pneumopathy (with initial preferential involvement of the left base, as may occur in the initial phases of systemic sclerosis or lupus)
- Localized actinic fibrosis due to radiotherapy of neoplasms of the left breast or esophagogastric junction.
Initial workup
High-resolution chest computed tomography (CT) (HRCT) with contrast; Forced spirometry and diffusing capacity for carbon monoxide (DLCO); Pleural and left basal parenchyma ultrasound; Bronchoscopy with sampling (bronchoalveolar lavage, brushing) of the left basal segments if a specific neoplastic or infectious cause is suspected.
red flags
Rapid increase in dull chest pain located at the left base, accelerated progression of habitual exertional dyspnea, appearance of recurrent hemoptoic sputum, or radiological evidence of an underlying mass that mimics or causes fibrosis in the left lower lobe.
Standard management
- Management is fundamentally etiological
- Nintedanib — 150 mg every 12 hours if part of a confirmed progressive fibrosing interstitial lung disease
- Prednisone — 20-40 mg orally per day if there is an interstitial inflammatory component or active organizing pneumonia
- Ibuprofen (400 mg orally every 8 hours if there is associated persistent pleuritic pain).
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