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Acute exacerbation of IPF — SCE Respiratory MCQ

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HardILDAcute exacerbation of IPFSCE Respiratory

A 76-year-old man with known IPF presents with 3 weeks of worsening breathlessness. CT pulmonary angiography excludes embolism but shows new bilateral ground-glass change superimposed on established UIP fibrosis. CRP is 16 mg/L, viral PCR is negative and echocardiography shows no new heart failure. What is the most likely diagnosis?

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Correct answer: C — Acute exacerbation of IPF

Acute respiratory deterioration with new bilateral ground-glass opacities on a background of UIP after excluding infection, PE and cardiac failure is most consistent with acute exacerbation of IPF. Cardiogenic oedema is less likely with a reassuring echocardiogram and no alternative cardiac features. Chronic hypersensitivity pneumonitis would not typically cause sudden diffuse ground-glass change over established UIP without an exposure clue.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/respiratory-conditions