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Instructions for how to take the HRCT challenge
1
As you proceed through the Challenge, you will be shown HRCT images and asked questions about predominant features and radiologic diagnoses.
2
Please select an answer to proceed with the Challenge.
3
The final series of questions will take you through a case study of a patient presenting with suspected interstitial lung disease.

The diagnosis may surprise you!

HRCT, high resolution computed tomography.
To review, here are the current criteria for diagnosing usual interstitial pneumonia by HRCT
Definite UIP
(All 4 features)

  • Subpleural, basal predominance
  • Reticular abnormality
  • Honeycombing
  • Absence or paucity of:
    • -Micronodules
    • -Discrete cysts
    • -Mosaic attenuation/air trapping
    • -Consolidation

Consistent with UIP
(All 3 features)

  • Subpleural, basal predominance
  • Reticular abnormality
  • Absence or paucity of:
    • -Profuse micronodules
    • -Discrete cysts
    • -Mosaic attenuation/air trapping
    • -Consolidation

Inconsistent with UIP
(Any of the 7 features)

  • Upper or mid-lung predominance
  • Peribronchovascular predominance
  • Extensive ground glass abnormality (extent > reticular abnormality)
  • Substantial extent of any of the following:
    • -Micronodules
    • -Discrete cysts
    • -Mosaic attenuation/air trapping
    • -Consolidation

Click images below to view

What are the predominant abnormalities in this series of HRCT scans?

Choose all that apply.

SUBMIT

Diagnosis and Conclusion of Case

 

Despite the patient's symptoms, pulmonary function testing, and radiology being consistent with a diagnosis of IPF, a comprehensive elicitation of medical history revealed a history of exposure to birds.

Serologic testing was positive for ANA, anti-Jo1, and SSA, leading to the diagnosis of autoimmune-associated interstitial pneumonia.

It is extremely important to elicit a thorough exposure history and to conduct serologic testing to eliminate alternative causes if a patient presents with suspected interstitial lung disease.
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you completed the HRCT challenge!

Your score: out of 10 correct

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Reference: Raghu G et al. Am J Respir Crit Care Med. 2011;183(6):788-824.