A 52-year-old non-smoker woman presents with 8 months of progressive exertional dyspnoea. HRCT shows basal-predominant subpleural reticulation with honeycombing and traction bronchiectasis. Bronchoalveolar lavage shows lymphocytosis 12%. Which ILD pattern is MOST consistent with this presentation?

• A Non-specific interstitial pneumonia (NSIP)
• B Cryptogenic organising pneumonia (COP)
• C Respiratory bronchiolitis ILD (RB-ILD)
• D Usual interstitial pneumonia (UIP) pattern consistent with IPF ✓

Explanation

The combination of basal-predominant subpleural reticulation with honeycombing, traction bronchiectasis, and absence of ground-glass opacity as the predominant feature defines the typical UIP pattern on HRCT. Idiopathic pulmonary fibrosis (IPF) is the most common cause and requires UIP pattern plus exclusion of other causes. BAL lymphocytosis is non-specific and mild here. NSIP shows predominant ground-glass with subpleural sparing. COP shows consolidation in a peribronchial distribution. RB-ILD occurs exclusively in smokers.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.