High-resolution computed tomography

Honeycombbing is less typical than in idiopathic pulmonary fibrosis.

A baseline HRCT can therefore be extremely useful for defining the phenotype and extent of pulmonary disease.

Now, does every patient need a biopsy? No.

Certain clinical syndromes are sufficiently characteristic that biopsy may not be necessary.

That, combined with clubbing of his fingertips, raised suspicion of an interstitial process rather than anything infective.

We arranged a high-resolution CT scan, HRCT, which showed a pattern consistent with usual interstitial pneumonia, with the classic honeycombing you look for at the lung bases.

Lung function testing backed this up, showing a restrictive pattern with a markedly reduced gas transfer factor, meaning his lungs weren't just smaller in volume, but were also less efficient at getting oxygen into the bloodstream.

Now, what I really want to highlight here is that his case went to our multidisciplinary team meeting, our MDT, before a formal diagnosis was confirmed.

On examination, the finding that really stood out was fine crackles at both lung bases, what we sometimes describe as sounding like Velcro being pulled apart.

That, combined with clubbing of his fingertips, raised suspicion of an interstitial process rather than anything infective.

We arranged a high-resolution CT scan, HRCT, which showed a pattern consistent with usual interstitial pneumonia, with the classic honeycombing you look for at the lung bases.

Lung function testing backed this up, showing a restrictive pattern with a markedly reduced gas transfer factor, meaning his lungs weren't just smaller in volume, but were also less efficient at getting oxygen into the bloodstream.