Fast Five Quiz: Idiopathic Pulmonary Fibrosis Differential Diagnosis

Guy W. Soo Hoo, MD, MPH


November 20, 2019

Because presenting signs and symptoms and HRCT findings are similar for NSIP and CHP, the definitive diagnosis is made histologically after surgical lung biopsy or bronchoscope cryobiopsy. The histologic pattern of NSIP has varying degrees of inflammation and fibrosis with temporal uniformity, unlike the temporal heterogeneity seen in patients with usual interstitial pneumonias such as IPF.

Erythrocyte sedimentation rate, C-reactive protein, and chest x-ray are all components of the NSIP workup, but are not required for definitive diagnosis.

Although thyroid-stimulating hormone, free triiodothyronine, and free thyroxine studies do not definitively diagnose NSIP, abnormalities in these hormones may be present in patients with NSIP because of the link between autoimmune disease and NSIP.

NSIP does respond to anti-inflammatory medications; however, a treatment trial response does not provide a definitive diagnosis.

For more on the differential diagnosis of NSIP, read here.


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