Interstitial Lung Disease – UIP

History: 60 year old male with history of diabetes and hypertension presents with chronic and acutely worsening shortness of breath. 

Figure 1: Single axial CT scan of the chest with lung windows shows extensive bibasal reticular opacities with honeycombing.

Figure 2: Single axial CT scan of the upper chest in lung windows. Again, peripherally based reticular opacities are seen. Note there is much less involvement of the lung apices.

The differential for honeycombing pattern is wide and includes entities such as usual interstitial pneumonia (UIP) and nonspecific interstitial pneumonia (NSIP), among others. The pattern implies end stage lung disease. The diagnosis in this case was UIP, with no known cause. In this case, the term idiopathic pulmonary fibrosis (IPF) applies.