A 65-year-old smoker has HRCT chest showing bilateral basal subpleural honeycombing, traction bronchiectasis, and minimal ground-glass opacity. The pattern is consistent with usual interstitial pneumonia (UIP). Current guidelines (2022 ATS/ERS/JRS/ALAT) require which combination for a definitive diagnosis of IPF?
- A UIP pattern on HRCT + surgical lung biopsy in all cases
- B UIP pattern on HRCT + bronchoalveolar lavage lymphocytosis
- C UIP pattern on HRCT alone in the appropriate clinical context (age >60, male, smoker) ✓
- D Probable UIP pattern requiring transbronchial cryobiopsy for confirmation
Correct answer: C. UIP pattern on HRCT alone in the appropriate clinical context (age >60, male, smoker)
Explanation
Per 2022 ATS/ERS/JRS/ALAT IPF guidelines, a 'typical UIP' pattern on HRCT (bilateral, basal, subpleural honeycombing with or without peripheral traction bronchiectasis, without features suggesting alternative diagnosis) in the appropriate clinical context (age >60, male, gradual onset exertional dyspnoea, basal crackles, no causative exposure/CTD) is sufficient for a confident diagnosis of IPF without surgical lung biopsy. Biopsy is reserved for 'probable UIP' or 'indeterminate' HRCT patterns. BAL lymphocytosis suggests an alternative diagnosis (NSIP, HP).
Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.
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