Image Challenge – February 24th

Question: What is the subpleural finding on this CT scan and what diagnosis could this suggest?

Reference here – Takeyuki Watadani, Fumikazu Sakai, Takeshi Johkoh, Satoshi Noma, Masanori Akira, Kiminori Fujimoto, Alexander A. Bankier, Kyung Soo Lee, Nestor L. Müller, Jae-Woo Song, Jai-Soung Park, David A. Lynch, David M. Hansell, Martine Remy-Jardin, Tomás Franquet, and Yukihiko Sugiyama
Radiology 2013 266:3, 936-944

Answer: The answer is honeycoming! All four of the following features on high-resolution CT are consistent with a usual interstitial pneumonia (UIP pattern) which can be seen in idiopathic pulmonary fibrosis (IPF). The four UIP criteria are:

  • Subpleural, basal predominance
  • Reticular abnormality
  • Honeycoming with or without traction bronchiectasis
  • Absence of features listed as inconsistent with UIP pattern which are:
    • Upper or mid-lung predominance
    • Prebronchovascular predominance
    • Extensive GGO abnormality (extent > reticular abnormality)
    • Profuse micronodules (bilateral, predominantly upper lobes)
    • Discrete cysts (multiple, bilateral, away from areas of honeycombing)
    • Diffuse mosaic attenuation/air-trapping (bilateral, in three or more lobes)
    • Consolidation in bronchopulmonary segment(s)/lobe(s)

Other references:

Raghu, G. et al. An Official ATS/ERS/JRS/ALAT Statement: Idiopathic Pulmonary Fibrosis: Evidence-based Guidelines for Diagnosis and Management. ATS Society Guidelines. Am J Respir Crit Care Med Vol 183. pp 788–824, 2011

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