Which feature speaks against IPF on HRCT?

Subpleural, basal predominance

Reticular abnormality

Honeycombing with or without traction bronchiectasis

Extensive ground glass abnormality (extent > reticular abnormality)

Correct answer: Extensive ground glass abnormality (extent > reticular abnormality) speaks against IPF. A usual interstitial pattern (UIP), which is characteristic of IPF, exhibits the following features:
  • Subpleural, basal predominance
  • Reticular abnormality
  • Honeycombing with or without traction bronchiectasis
The presence of extensive ground glass abnormality (extent > reticular abnormality) is inconsistent with UIP pattern and should lead to an alternative diagnosis.

Raghu G, et al. An official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: Evidence-based guidelines for diagnosis and management. Am J Respir Crit Care Med 2011;183(6):788-824.
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