A 40-year-old non-smoker woman presents with 2 years of progressive dyspnea and dry cough. HRCT shows bilateral basal-predominant subpleural honeycombing with traction bronchiectasis and reticular opacities, without ground-glass opacity predominance. Pulmonary function tests show a restrictive pattern with reduced DLCO. What is the most likely diagnosis?
- A Hypersensitivity pneumonitis
- B Non-specific interstitial pneumonia (NSIP)
- C Cryptogenic organizing pneumonia (COP)
- D Usual interstitial pneumonia / idiopathic pulmonary fibrosis ✓
Explanation
The HRCT pattern of bilateral, basal-predominant, subpleural honeycombing with traction bronchiectasis and reticular opacities is the hallmark of usual interstitial pneumonia (UIP), which correlates pathologically with idiopathic pulmonary fibrosis (IPF) in the absence of identifiable cause. IPF has a median survival of 3–5 years; anti-fibrotic agents (nintedanib or pirfenidone) slow decline in FVC but do not reverse disease. NSIP shows bilateral ground-glass opacity and lower lobe fibrosis without honeycombing; hypersensitivity pneumonitis has upper/mid-lobe predominance.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.