What pattern is shown in this image?

Honeycombing

Paraseptal emphysema

Bronchiectasis

Irregular reticulation

Author’s solution
  • In this image there is an irregular reticular pattern with bronchiectasis/bronchiolectasis (blue circle).
  • The distribution is basal/subpleural.
  • In the absence of features inconsistent with UIP pattern the radiologic diagnosis is that of possible UIP pattern.
  • As an incidental finding, Morgagni hernia is recognised.
  • Based on the current guidelines, in order to establish the diagnosis of IPF, a lung biopsy would be recommended. However, in clinical practice when alternative diagnoses are excluded, the presence of possible UIP pattern on HRCT (i.e. without the presence of honeycombing) is considered sufficient to form a “working diagnosis” and start treatment.

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