Which physical findings are characteristic of diffuse parenchymal lung diseases (DPLDs)?

Updated: Sep 15, 2020
  • Author: Eleanor M Summerhill, MD, FACP, FCCP; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Varied etiologies make generalization of physical examination findings difficult for patients with DPLD. However, clinical examination findings noted in patients with idiopathic pulmonary fibrosis are frequently noted in patients with other DPLDs.

Patients frequently are dyspneic, which may be more pronounced with activity and generally is associated with an accompanying tachypnea. Central cyanosis may be present if significant hypoxemia and arterial oxygen desaturation are present. Fine end-inspiratory pulmonary rales (Velcro rales) are a common finding and may be difficult to distinguish from those auscultated in patients with congestive heart failure. Pulmonary sarcoidosis and other granulomatous disorders are often an exception. Wheezes may be heard and reflect airway involvement, as in sarcoidosis. A pulmonary squawk has been described with HSP. A right-sided gallop (S3), an accentuated second heart sound (P2) with fixed or paradoxic splitting, and a right ventricular lift may be present. These indicate the presence of cor pulmonale. Digital clubbing may accompany many of these disorders, as previously discussed.

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