On HRCT chest, bilateral basal predominant subpleural reticulation with honeycombing and traction bronchiectasis is described. This pattern is most consistent with which interstitial lung disease?
- A Non-specific interstitial pneumonia (NSIP)
- B Respiratory bronchiolitis-ILD (RB-ILD)
- C Usual interstitial pneumonia (UIP) — idiopathic pulmonary fibrosis ✓
- D Hypersensitivity pneumonitis
Explanation
The UIP pattern on HRCT — bilateral, basal, subpleural, posterior predominant reticulation with honeycombing (subpleural cysts in layers) and traction bronchiectasis with relative sparing of ground-glass opacity — is the hallmark of IPF. The temporal and spatial heterogeneity with honeycombing distinguishes UIP from NSIP (which shows ground-glass >reticulation, subpleural sparing, and NO honeycombing). RB-ILD shows centrilobular ground-glass nodules in smokers. Hypersensitivity pneumonitis shows upper/mid-zone predominance with mosaic attenuation and lobular air trapping.
Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.