A 58-year-old woman presents with 10 months of progressive exertional dyspnea and dry cough. HRCT chest shows bilateral, symmetric, basal-predominant ground-glass opacities with fine reticulation and subpleural sparing. Traction bronchiectasis is present. There is no honeycombing. Which diagnosis is most likely?

• A Usual interstitial pneumonia (UIP)
• B Respiratory bronchiolitis-associated ILD (RB-ILD)
• C Cryptogenic organizing pneumonia (COP)
• D Nonspecific interstitial pneumonia (NSIP) ✓

Explanation

NSIP classically shows bilateral symmetric ground-glass opacities with subpleural sparing, basal predominance, and traction bronchiectasis without honeycombing. Subpleural sparing is the distinguishing feature from UIP, which shows subpleural honeycombing. COP presents with peripheral consolidation. RB-ILD occurs in smokers with centrilobular nodules. NSIP has a better prognosis than UIP and often responds to corticosteroids.

Reference: Murray and Nadel's Textbook of Respiratory Medicine, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.