Usual interstitial pneumonia: typical and atypical high-resolution computed tomography features

Area of Science:

• Pulmonology
• Radiology
• Pathology

Background:

• Usual interstitial pneumonia (UIP) has characteristic computed tomography (CT) findings, including basal and peripheral reticular abnormalities and honeycombing.
• Complications such as pulmonary hypertension, lung cancer, and acute exacerbation can be detected via CT.
• The number of surgical lung biopsies for typical UIP is decreasing.

Purpose of the Study:

• To highlight the increasing discordance between computed tomography (CT) features and histologic findings of usual interstitial pneumonia (UIP).
• To explore reasons for this discordance.
• To emphasize the importance of multidisciplinary diagnosis in resolving these cases.

Main Methods:

• Review of computed tomography (CT) findings in usual interstitial pneumonia (UIP).
• Analysis of cases with discordance between CT features and histologic diagnosis.
• Discussion of potential contributing factors to diagnostic discrepancies.

Main Results:

• Histologic findings of UIP are increasingly identified in patients with atypical CT features.
• Reasons for discordance include pathologist interpretation variability, biopsy sampling errors, nonrepresentative biopsy sites, coexisting pathologies, and familial pulmonary fibrosis.
• Multidisciplinary diagnosis is crucial for accurate case resolution.

Conclusions:

• Discordance between CT and histology in usual interstitial pneumonia (UIP) is a growing concern.
• Accurate diagnosis requires careful consideration of multiple factors beyond imaging.
• Multidisciplinary team collaboration is essential for managing complex cases of interstitial lung disease.