Question:
A 45 year old male patient presented with chronic cough and SOB, on examination infrascapular crepitationts present, CT shows Usual interstitial pneumonia (UIP) pattern ILD. Which of the following is the least likely diagnosis?
A 45 year old male patient presented with chronic cough and SOB, on examination infrascapular crepitationts present, CT shows Usual interstitial pneumonia (UIP) pattern ILD. Which of the following is the least likely diagnosis?
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To differentiate ILD patterns on HRCT:
UIP: Basal, subpleural, honeycombing, traction bronchiectasis. (Seen in IPF, Rheumatoid Arthritis, Asbestosis).
NSIP: Ground-glass opacities, subpleural sparing, less honeycombing. (Common in Systemic Sclerosis, other CTDs).
Sarcoidosis: Upper lobe predominance, perilymphatic nodules, hilar lymphadenopathy.
UIP: Basal, subpleural, honeycombing, traction bronchiectasis. (Seen in IPF, Rheumatoid Arthritis, Asbestosis).
NSIP: Ground-glass opacities, subpleural sparing, less honeycombing. (Common in Systemic Sclerosis, other CTDs).
Sarcoidosis: Upper lobe predominance, perilymphatic nodules, hilar lymphadenopathy.
Updated On: Sep 3, 2026
- Systemic sclerosis
- Sarcoidosis
- Rheumatoid arthritis
- Idiopathic pulmonary fibrosis (IPF)
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The Correct Option is B
Solution and Explanation
Concept:
The patient presents with clinical signs of interstitial lung disease (ILD): chronic cough, shortness of breath, and classic fine end-inspiratory ("Velcro") infrascapular crepitations.
High-Resolution CT (HRCT) of the chest reveals a Usual Interstitial Pneumonia (UIP) pattern.
The objective is to identify which condition among the options is the least likely to cause a UIP pattern.
Explanation:
• A Usual Interstitial Pneumonia (UIP) pattern on HRCT is characterized by reticular opacities predominantly located in the basal and subpleural regions of the lungs.
• The hallmark feature of definite UIP is the presence of "honeycombing" (clustered cystic airspaces with well-defined walls), often accompanied by traction bronchiectasis.
• Importantly, UIP features a relative absence of ground-glass opacities, which differentiates it from other patterns like Non-Specific Interstitial Pneumonia (NSIP).
• UIP is the defining radiological and histopathological pattern of Idiopathic Pulmonary Fibrosis (IPF), making option (D) a very common cause.
• However, the UIP pattern is not exclusive to IPF; it can be secondary to connective tissue diseases (CTDs).
• Rheumatoid arthritis (RA) related ILD predominantly manifests as a UIP pattern.
• Systemic sclerosis (scleroderma) most commonly presents with an NSIP pattern, but a UIP pattern is also a well-recognized and common presentation.
• In stark contrast, Sarcoidosis is a granulomatous disease that typically affects the mid to upper lung zones.
• The classic HRCT pattern for pulmonary sarcoidosis includes perilymphatic nodules distributed along the bronchovascular bundles, subpleural regions, and interlobular septa, often with bilateral hilar lymphadenopathy.
• Advanced sarcoidosis can cause fibrosis, but it manifests as upper lobe distortion and conglomerate masses, not as the basal, subpleural honeycombing typical of UIP.
• Therefore, sarcoidosis is highly unlikely to present primarily with a UIP pattern on CT.
Final answer:
Sarcoidosis is the least likely diagnosis, as it typically presents with upper/mid zone nodular patterns rather than a basal UIP pattern.
The patient presents with clinical signs of interstitial lung disease (ILD): chronic cough, shortness of breath, and classic fine end-inspiratory ("Velcro") infrascapular crepitations.
High-Resolution CT (HRCT) of the chest reveals a Usual Interstitial Pneumonia (UIP) pattern.
The objective is to identify which condition among the options is the least likely to cause a UIP pattern.
Explanation:
• A Usual Interstitial Pneumonia (UIP) pattern on HRCT is characterized by reticular opacities predominantly located in the basal and subpleural regions of the lungs.
• The hallmark feature of definite UIP is the presence of "honeycombing" (clustered cystic airspaces with well-defined walls), often accompanied by traction bronchiectasis.
• Importantly, UIP features a relative absence of ground-glass opacities, which differentiates it from other patterns like Non-Specific Interstitial Pneumonia (NSIP).
• UIP is the defining radiological and histopathological pattern of Idiopathic Pulmonary Fibrosis (IPF), making option (D) a very common cause.
• However, the UIP pattern is not exclusive to IPF; it can be secondary to connective tissue diseases (CTDs).
• Rheumatoid arthritis (RA) related ILD predominantly manifests as a UIP pattern.
• Systemic sclerosis (scleroderma) most commonly presents with an NSIP pattern, but a UIP pattern is also a well-recognized and common presentation.
• In stark contrast, Sarcoidosis is a granulomatous disease that typically affects the mid to upper lung zones.
• The classic HRCT pattern for pulmonary sarcoidosis includes perilymphatic nodules distributed along the bronchovascular bundles, subpleural regions, and interlobular septa, often with bilateral hilar lymphadenopathy.
• Advanced sarcoidosis can cause fibrosis, but it manifests as upper lobe distortion and conglomerate masses, not as the basal, subpleural honeycombing typical of UIP.
• Therefore, sarcoidosis is highly unlikely to present primarily with a UIP pattern on CT.
Final answer:
Sarcoidosis is the least likely diagnosis, as it typically presents with upper/mid zone nodular patterns rather than a basal UIP pattern.
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