CTICasesConfluent Bronchiectasis Mimicking UIP
Imaging findings
Chest radiograph shows a bubbly appearance at the lung bases with preserved lung volumes. High-resolution CT demonstrates thin-walled peripheral cysts resembling honeycombing but lacking a typical dense fibrotic matrix, extending up to the apices. Pathologic correlation reveals confluent bronchiectasis with ciliated respiratory epithelium lining the cysts, and interstitial hemosiderin-laden macrophages with iron-encrusted elastic tissue.
Key takeaways
Pseudo-honeycombing or bubbly lung disease can present as thin-walled cystic spaces that mimic honeycombing radiographically but lack the dense fibrotic matrix of typical usual interstitial pneumonia (UIP). Pathologically, these spaces represent confluent bronchiectasis and may be associated with giant cell reaction to iron-encrusted elastic tissue, potentially seen in connective tissue diseases like rheumatoid arthritis.
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