CTICasesChronic Hypersensitivity Pneumonitis
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Imaging findings
Radiographs show chronic interstitial fibrosing lung disorder. CT reveals subpleural opacities, areas of traction bronchiectasis, and involvement of both lower and upper lung zones, though somewhat asymmetric (more right lower, left upper). There is clear peribronchial disease and central fibrosis. Notably, there is no honeycombing, and the distribution is not typical for UIP.
Key takeaways
Chronic hypersensitivity pneumonitis can be challenging to diagnose, and occult avian antigens (e.g., from feather bedding) are an underappreciated cause. In some cases initially diagnosed as IPF/UIP, a revised diagnosis of chronic HP may be made after more extensive evaluation. The absence of honeycombing and a distribution inconsistent with UIP (e.g., upper lung involvement, peribronchial disease) should raise suspicion for HP. Air trapping, if present, is a helpful sign, but its absence in later stages of fibrosis does not exclude the diagnosis.
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