20th February 2025

A 74-year-old woman is referred by her GP with a suspected diagnosis of interstitial lung disease.

A 74-year-old woman is referred by her GP with a suspected diagnosis of interstitial lung disease. 

She has been increasingly short of breath on exertion over the last year. She reports no chest pain, palpitations or ankle swelling.

Her past medical history includes ischaemic heart disease, atrial fibrillation and diabetes. Her medications include ramipril, bisoprolol, amiodarone and metformin. She is allergic to penicillin.

Her blood tests show: Hb 100 g/L (M 130-180 g/L; F 115-165 g/L), WCC 7×10⁹ /L (4-11×10⁹ /L), Plt 243×10⁹ /L (150-450×10⁹ /L), MCV 100 fL (80-100 fL), Na 137 mmoL/L (133-146 mmoL/L), K 4.3 mmol/L (3.5-5.3 mmoL/L), Urea 5 mmol/L (2.5-7.8 mmoL/L), Creatinine 68 μmol/ L (M 59-104 μmol/ L; F 45-84 μmol/ L). An autoimmune screen was unremarkable. 

CXR showed bibasal reticular shadowing and small lungs.

Which pattern must be seen on HRCT to confirm the diagnosis of idiopathic pulmonary fibrosis?

Select the SINGLE most appropriate option from the list below. Select ONE option only.