CTICasesAcute Exacerbation of Idiopathic Pulmonary Fibrosis (UIP pattern) with Organizing Pneumonia pattern
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Imaging findings
Prior radiograph and CT showed pleural reticulation, basil predominance, and traction bronchiectasis, consistent with a possible UIP pattern. Acutely, there was new patchy peripheral ground-glass opacity superimposed on this process. This appeared more like areas of organizing pneumonia rather than the extensive ground-glass usually seen with acute alveolar damage.
Key takeaways
The organizing pneumonia pattern explained why the patient only required two liters of oxygen and was more normal centrally, suggesting a likely response to steroids. The acute exacerbation was probably induced by a viral infection (flu-like illness several weeks prior) but manifesting primarily as organizing pneumonia. Clinical context (older, former smoker, no connective tissue disease) strongly suggested IPF, making biopsy unnecessary. The distinction between UIP and fibrotic NSIP on imaging can be challenging, and even pathologists may not agree.
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