CTICasesProgression of fibrotic hypersensitivity pneumonitis
Imaging findings
Initial CT shows upper-zone predominant pulmonary fibrosis with traction bronchiectasis and relative subpleural sparing. Three years later, follow-up CT demonstrates progression of the fibrosis down to the lung bases.
Key takeaways
While fibrotic HP classically presents with mid-to-upper lung predominant fibrosis, progressive remodeling can lead to diffuse, basal-predominant fibrosis that mimics UIP. Comparing with earlier scans is critical to identify the initial upper-lobe distribution.
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