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Hypersensitivity pneumonitis — SCE Respiratory MCQ

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ModerateILDHypersensitivity pneumonitisSCE Respiratory

A 46-year-old pigeon breeder has episodic fever, cough and breathlessness that worsen after cleaning his loft. HRCT shows centrilobular ground-glass nodules, mosaic attenuation and air trapping on expiratory imaging. FVC is 78% predicted and TLCO is 52% predicted. What is the most likely diagnosis?

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Correct answer: B — Hypersensitivity pneumonitis

Exposure to avian antigen with centrilobular nodules, mosaic attenuation and air trapping is typical of hypersensitivity pneumonitis. IPF would usually show basal subpleural UIP, while sarcoidosis favours perilymphatic nodules and hilar lymphadenopathy. Aspergillosis and eosinophilic asthma would not produce this small-airway/interstitial CT pattern linked to antigen exposure.

Reference: ATS/JRS/ALAT Hypersensitivity Pneumonitis Guideline; BTS ILD guidance