HRCT chest in a 60-year-old man shows bilateral basal-predominant, subpleural reticular opacities with honeycombing and traction bronchiectasis WITHOUT ground-glass opacity predominance. The UIP pattern on HRCT in the correct clinical context is diagnostic of:

• A Nonspecific interstitial pneumonia (NSIP)
• B Cryptogenic organizing pneumonia (COP)
• C Hypersensitivity pneumonitis (HP)
• D Idiopathic pulmonary fibrosis (IPF) ✓

Explanation

Usual interstitial pneumonia (UIP) pattern on HRCT — characterized by bilateral subpleural basal-predominant reticular opacities, honeycombing with or without peripheral traction bronchiectasis, and minimal or no ground-glass opacity — is the hallmark imaging pattern of IPF when occurring in the appropriate clinical context (age >60, male, smoker, progressive fibrotic respiratory symptoms). In 2022 ATS/ERS guidelines, a typical UIP pattern on HRCT allows diagnosis of IPF without surgical lung biopsy. NSIP shows ground-glass opacity > reticulation without honeycombing. COP shows consolidation in a peribronchial/subpleural distribution.

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

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Written and medically reviewed by the StethoPrep medical team.