HRCT chest shows bilateral basal-predominant subpleural reticulation, honeycombing with traction bronchiectasis, and ground-glass opacity. Bronchoalveolar lavage shows lymphocytosis. The pattern corresponds to which ILD on UIP-pattern scoring?

• A Typical UIP pattern — diagnostic of IPF
• B Probable UIP — IPF possible but alternate diagnoses not excluded
• C Indeterminate UIP
• D Alternative diagnosis (non-UIP) — BAL lymphocytosis suggests HP or NSIP ✓

Explanation

While the HRCT shows features suggestive of UIP (honeycombing, basal subpleural reticulation, traction bronchiectasis), the BAL lymphocytosis is atypical for IPF and should prompt consideration of hypersensitivity pneumonitis (HP) or non-specific interstitial pneumonia (NSIP). Per 2022 ATS/ERS guidelines, BAL lymphocytosis is a feature that argues against IPF and supports alternative diagnoses. IPF BAL characteristically shows neutrophilia.

Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.