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UIP on HRCT — SCE Respiratory MCQ

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ModerateImagingUIP on HRCTSCE Respiratory

A 70-year-old man has progressive dyspnoea and bibasal crackles. HRCT shows basal and subpleural reticulation, traction bronchiectasis and stacked subpleural cystic airspaces; there is no profuse micronodularity or consolidation. FVC is 72% predicted and TLCO is 44% predicted. Autoimmune testing and exposure review are negative. What is the most likely diagnosis?

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Correct answer: E — Usual interstitial pneumonia pattern

The CT description is classic for UIP, particularly basal subpleural fibrosis with honeycombing and traction bronchiectasis. NSIP usually has more ground-glass change and relative subpleural sparing. CT pattern classification strongly influences whether surgical lung biopsy is needed.

Reference: ATS/ERS/JRS/ALAT IPF Guideline 2022; NICE CG163