CTICasesNon-Specific Interstitial Pneumonia (NSIP)
Imaging findings
High-resolution chest CT shows sparse subpleural reticulation, focal subpleural traction bronchiectasis, and a relative lack of basal-predominant disease or classic honeycombing, placing the imaging findings in the indeterminate category for usual interstitial pneumonia. Surgical lung biopsy reveals a difficult-to-classify fibrosing interstitial pneumonia with occasional fibroblast foci and features primarily suggesting cellular and fibrotic non-specific interstitial pneumonia.
Key takeaways
When interstitial lung disease findings on CT are indeterminate, pathologists can struggle with classification just as much as radiologists, often finding overlapping histopathologic features of non-specific interstitial pneumonia, usual interstitial pneumonia, or airway-centered fibrosis. Many indeterminate cases that do not fit classic diagnostic criteria represent familial fibrosis or connective tissue diseases that require extended autoimmune testing and longitudinal clinical correlation.
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