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Interstitial lung disease — ABIM Board MCQ

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ModeratePulmonary/Critical CareInterstitial lung diseaseABIM Board

A 64-year-old has progressive exertional dyspnea, dry cough, clubbing, bibasilar crackles, restrictive spirometry and reduced DLCO. Which study best characterizes the suspected fibrotic interstitial-lung-disease pattern?

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Correct answer: C — Obtain high-resolution CT of the chest with an ILD protocol

The best answer is “Obtain high-resolution CT of the chest with an ILD protocol”. High-resolution CT defines the distribution and morphologic pattern of fibrosis, including whether usual interstitial pneumonia is present, and guides multidisciplinary diagnosis and the need for further sampling. Spirometric reversibility, oximetry and D-dimer address different questions; ventilation-perfusion scanning evaluates perfusion rather than parenchymal fibrosis.

Reference: 2018 ATS/ERS/JRS/ALAT Idiopathic Pulmonary Fibrosis Diagnostic Guideline: https://pubmed.ncbi.nlm.nih.gov/30168753/