Different fibrotic ILDs on HRCT
You have an essential role in the evaluation of suspected fibrotic ILD, as chest HRCT can aid differential and definite diagnosis1–4
Consideration of potential co-occurrence/overlap of HRCT features and the distribution of abnormalities in the axial and coronal planes can help narrow the differential diagnosis.5
Idiopathic pulmonary fibrosis (IPF)
Sourced from: Imaging Atlas of ILDs
The typical HRCT feature of IPF is UIP, which is characterized by the presence of reticulation, traction bronchiectasis, and honeycombing in a basal and peripheral predominant distribution.2,5
Chronic hypersensitivity pneumonitis (cHP)
Sourced from: Imaging Atlas of ILDs
Chronic fibrotic hypersensitivity pneumonitis is difficult to diagnose, with possible UIP pattern often seen on HRCT, though a distinguishing radiological feature can be air trapping.6
Systemic sclerosis-associated interstitial lung disease (SSc-ILD)
Sourced from: Imaging Atlas of ILDs
Most SSc-ILD patients have a fibrotic NSIP pattern on HRCT, with a high proportion of ground-glass opacities, including presence of reticulation and traction bronchiectasis, although a UIP pattern may be seen in a small proportion of patients.6,7
Rheumatoid arthritis-associated interstitial lung disease (RA-ILD)
Sourced from: Imaging Atlas of ILDs
UIP is the most common HRCT pattern in RA-ILD, which is characterized by reticulation, honeycombing and traction bronchiectasis.8
ILD PATIENT CASES
Download our patient cases for specific ILDs to see the clinical histories, physical evaluations, and HRCT diagnostic findings of representative patients.
Stephanie has SSc-ILD
How can you build a clinical picture of SSc-ILD?
Julie has RA-ILD
How can you confirm suspicion of RA-ILD?
Footnotes
cHP, chronic hypersensitivity pneumonitis; HRCT, high-resolution computed tomography; ILD, interstitial lung disease; IPF, idiopathic pulmonary fibrosis; NSIP, non-specific interstitial pneumonia; RA-ILD; rheumatoid arthritis-associated interstitial lung disease; SSc-ILD, systemic sclerosis-associated interstitial lung disease; UIP, usual interstitial pneumonia.
- Chung J, Goldin J. Interpretation of HRCT scans in the diagnosis of IPF: improving communication between pulmonologists and radiologists. Lung. 2018;196(5):561–567.
- Raghu G, Remy-Jardin M, Richeldi L et al. Idiopathic Pulmonary Fibrosis (an update) and progressive pulmonary fibrosis in adults. An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline. Am J Respir Crit Care Med. 2022;205:e18–e47.
- Cottin V, Valenzuela C. Diagnostic approach of fibrosing interstitial lung diseases of unknown origin. Presse Med. 2020;49(2):104021.
- Mohning MP, Richards JC, Huie TJ. Idiopathic pulmonary fibrosis: the radiologist’s role in making the diagnosis. Br J Radiol. 2019;92(1099):20181003.
- Elicker B, de Castro Pereira CA, Webb R, Leslie KO. High-resolution computed tomography patterns of diffuse interstitial lung disease with clinical and pathological correlation. J Bras Pneumol. 2008;34(9):715–744.
- Cottin V, Hirani N, Hotchkin D, et al. Presentation, diagnosis and clinical course of the spectrum of progressive-fibrosing interstitial lung diseases. Eur Respir Rev. 2018;27(150):180076.
- Perelas A, Silver RM, Arrossi AV, et al. Systemic sclerosis-associated interstitial lung disease. Lancet Respir Med. 2020;8(3):304–320.
- Iqbal K, Kelly C. Treatment of rheumatoid arthritis-associated interstitial lung disease: a perspective review. Ther Adv Musculoskelet Dis. 2015;7(6):247–267.
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