CTICasesExuberant Honeycombing in Connective Tissue Disease
Imaging findings
CT chest shows progressive pulmonary fibrosis with reticulation and a striking pattern of large, confluent, and exuberant cystic spaces (honeycombing) predominantly in the lower lobes and subpleural areas, which is atypical for standard idiopathic UIP and highly suggestive of rheumatoid arthritis or Sjögren syndrome.
Key takeaways
Exuberant honeycombing is an atypical pattern of pulmonary fibrosis strongly associated with connective tissue diseases (CTD-ILD), particularly rheumatoid arthritis and Sjögren syndrome. Recognizing these large, stacked cystic spaces can help differentiate CTD-ILD from idiopathic pulmonary fibrosis (IPF/UIP), which typically exhibits smaller, more uniform honeycomb cysts.
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