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Idiopathic pulmonary fibrosis — SCE Respiratory MCQ

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EasyInterstitial Lung DiseaseIdiopathic pulmonary fibrosisSCE Respiratory

A 71-year-old man has 9 months of progressive exertional breathlessness and dry cough. Bibasal fine crackles are present and oxygen saturation falls from 96% to 86% on walking. HRCT shows basal subpleural reticulation, traction bronchiectasis and honeycombing with no ground-glass predominance. FVC is 74% predicted and TLCO is 39% predicted. What is the most likely diagnosis?

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Correct answer: E — Chronic hypersensitivity pneumonitis

The HRCT pattern is usual interstitial pneumonia with basal subpleural fibrosis, traction bronchiectasis and honeycombing in an older man, making IPF the most likely diagnosis. Chronic hypersensitivity pneumonitis usually has exposure history, mosaic attenuation or upper/mid-zone predominance. Organising pneumonia and sarcoidosis would not typically produce classic honeycombing with this distribution.

Reference: NICE CG163; ATS/ERS/JRS/ALAT IPF guideline