Usual Interstitial Pneumonia

March 28, 2013



Case History: A 55-year-old female presented with complaints of progressive dyspnoea with dry cough for more than one year. She has a past history of pulmonary tuberculosis six years ago for which she received treatment and was sputum negative after that. She had severe breathlessness and was intubated for the same during her present admission. Chest CT was done.

[[{"type":"media","view_mode":"media_crop","fid":"12225","attributes":{"alt":"","class":"media-image","id":"media_crop_1330432748319","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"385","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","title":" ","typeof":"foaf:Image"}}]]

[[{"type":"media","view_mode":"media_crop","fid":"12226","attributes":{"alt":"","class":"media-image","id":"media_crop_9598340601883","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"391","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","title":" ","typeof":"foaf:Image"}}]]

[[{"type":"media","view_mode":"media_crop","fid":"12232","attributes":{"alt":"","class":"media-image","id":"media_crop_966780433998","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"392","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","title":" ","typeof":"foaf:Image"}}]]

[[{"type":"media","view_mode":"media_crop","fid":"12233","attributes":{"alt":"","class":"media-image","id":"media_crop_2267695732289","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"393","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","title":" ","typeof":"foaf:Image"}}]]

[[{"type":"media","view_mode":"media_crop","fid":"12234","attributes":{"alt":"","class":"media-image","id":"media_crop_8355182609789","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"394","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","title":" ","typeof":"foaf:Image"}}]]

Findings:
1. Multiple subpleural areas of honeycombing with cystic spaces outlined by thick fibrous walls, with basal predominance
2. Patchy areas of interlobular septal thickening interspersed with areas of ground glass opacities and normal lung parenchyma
3. Bilateral areas of traction bronchiectasis due to interstitial fibrosis along with architectural distortion of the secondary pulmonary lobule
4. Mild mediastinal lymphadenopathy

Differential diagnosis to be considered are usual interstitial pneumonia and idiopathic pulmonary fibrosis. Histology confirmed the diagnosis of usual interstitial pneumonia/idiopathic pulmonary fibrosis.
The disease maybe complicated by bronchogenic carcinoma. Prognosis is usually poor with only 10 percent to 15 percent of cases responding to steroids, with an average survival of three to six years.

Ankur Wadhera, MD
Resident, Department of Radiodiagnosis, Christian Medical College, Ludhiana.
Punjab, India