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Idiopathic pulmonary fibrosis — SCE Respiratory MCQ

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ModerateILDIdiopathic pulmonary fibrosisSCE Respiratory

A 72-year-old man has 18 months of progressive exertional dyspnoea and dry cough. HRCT shows basal, subpleural reticulation with honeycombing and traction bronchiectasis; there is no significant ground-glass opacity. FVC is 72% predicted and TLCO is 42% predicted. Autoimmune serology is negative. What is the most likely diagnosis?

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Correct answer: A — Idiopathic pulmonary fibrosis

A definite UIP pattern on HRCT in the right clinical context strongly supports IPF. Fibrotic HP may mimic UIP but often has exposure history, mosaic attenuation or air trapping; NSIP tends to show more ground-glass change with relative subpleural sparing. Sarcoidosis and organising pneumonia have different radiological distributions and tempo.

Reference: ATS/ERS/JRS/ALAT IPF Guideline 2022; NICE IPF guidance