Correct!
5. Usual interstitial pneumonia / idiopathic pulmonary fibrosis
Among the choices listed, the most likely cause for the findings on the chest radiograph is usual interstitial pneumonia / idiopathic pulmonary fibrosis (UIP / IPF). The chest radiographic findings are potentially consistent with this disorder, though certainly not diagnostic of it- the lung volumes are not abnormally decreased, as is often the case with UIP / IPF, nor is there visible honeycombing. Furthermore, the pulmonary opacities in UIP / IPF are often more peripherally distributed, and small reticular opacities in the subpleural lung, rather than the longer linear opacities evident on this image, are commonly seen with UIP / IPF. Linear and reticular opacities with architectural distortion, suggesting fibrotic lung disease, may occur with sarcoidosis, but typically such findings are upper lobe predominant, not lower lobe predominant. Granulomatosis with polyangiitis (Wegener’s granulomatosis) often manifests at chest radiography with multiple, bilateral, variably-sized nodules and cavities, or perhaps diffuse pulmonary opacities resulting from pulmonary hemorrhage- neither are evident in this case. The imaging manifestations of coccidioidomycosis are protean, typically including consolidation with lymph node enlargement, miliary disease, single or multiple nodules, or single or multiple cavities of variable wall thickness, among other possibilities; however, basal linear and reticular opacities are typically not a manifestation of pulmonary coccidioidomycosis infection. Finally, basal predominant linear opacities (often representing interlobular septal thickening) are commonly seen in patients with increased pressure edema (congestive heart failure), but usually other radiographic abnormalities are present, typically cardiomegaly, a widened vascular pedicle, and pleural effusions. Such abnormalities are not present in this case.
The patient was treated with broad spectrum antibiotics and diuresis, but was lost to follow up. Four years later, a repeat chest radiograph (Figure 2) was performed when the patient again presented with complaints of intermittent shortness of breath.
Figure 2. Frontal (A) and lateral (B) chest radiography performed 4 years following Figure 1.
Which of the following statements regarding the chest radiograph is most accurate?