On HRCT of a patient with suspected UIP/IPF, which combination of features confirms a 'typical UIP pattern' and allows diagnosis without surgical lung biopsy?
- A Bilateral basal-predominant honeycombing ± peripheral traction bronchiectasis, absence of features suggesting alternative diagnosis ✓
- B Bilateral upper-lobe ground-glass opacity with centrilobular nodules
- C Mosaic attenuation with air-trapping on expiratory CT
- D Bilateral pleural plaques with subpleural bands
Correct answer: A. Bilateral basal-predominant honeycombing ± peripheral traction bronchiectasis, absence of features suggesting alternative diagnosis
Explanation
A typical UIP pattern on HRCT is defined by bilateral, basal, subpleural-predominant honeycombing (with or without peripheral traction bronchiectasis/bronchiolectasis) in the absence of features suggesting an alternative diagnosis (such as upper-lobe predominance, peribronchovascular distribution, extensive ground-glass, profuse micronodules, discrete cysts away from areas of honeycombing, or diffuse mosaic attenuation). This combination allows a confident diagnosis of IPF without surgical biopsy per ATS/ERS guidelines.
Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.
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