Case Study Discussion

Is the CT sufficient to make a diagnosis? With this type of CT with lower lobe predominant, subpleural reticulation, regional architectural distortion, and clear honeycomb change, a biopsy is not required. The real issue becomes whether we have excluded all other possibilities that could also give this type of CT pattern. There is no substantial evidence pointing to any other disease, and this patient is the right age and gender, has the right list of comorbidities, and the absence of other signs or symptoms pointing to an alternative cause, so it is quite likely that he has idiopathic pulmonary fibrosis. There are questions that arise during the clinical evaluation, such as the mechanic's hands, the possibility of mold in the basement, and whether the arthritis is osteoarthritis or rheumatoid arthritis. Each of these were considered in this case and worked out, so we are comfortable making a confident diagnosis of idiopathic pulmonary fibrosis.