CTICasesFibrotic Hypersensitivity Pneumonitis
Imaging findings
Chest radiography shows mild, bi-basilar reticular opacities. Chest computed tomography demonstrates mild, subpleural-predominant reticulation and sparse punctate calcifications or ossifications without significant traction bronchiectasis or subpleural cysts, rendering it indeterminate for usual interstitial pneumonia. Surgical lung biopsy pathology reveals airway-centric interstitial inflammation and fibrosis, occasional loose non-necrotizing granulomas, and foci of dendriform pulmonary ossification.
Key takeaways
The presence of airway-centric fibrosis, loose granulomas, and dendriform pulmonary ossification on surgical lung biopsy is highly suggestive of chronic, fibrotic hypersensitivity pneumonitis. In many cases of interstitial lung disease, the imaging and pathologic findings are subtle and may not fit perfectly into standard guidelines, emphasizing the importance of multidisciplinary discussion and exposure history.
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