Skill Checkup: A 63-Year-Old Man With Persistent Cough and New Shortness of Breath

Zab Mosenifar, MD


April 21, 2022

This patient presents with hallmark HCRT findings of IPF, so serologic testing to exclude connective tissue disease as a potential cause of the ILD is the greatest priority for workup.

When patients with newly detected ILD of unknown cause are clinically suspected of having IPF and have an HRCT pattern of UIP, guidelines from the American Thoracic Society, European Respiratory Society, The Japanese Respiratory Society, and the Latin American Thoracic Society recommend against performing cellular analysis of bronchoalveolar lavage fluid, surgical lung biopsy, transbronchial lung biopsy, and lung cryobiopsy. These workup approaches should, however, be undertaken if HRCT results show probable UIP, indeterminate for UIP, or an alternative diagnosis.

In the present case, it is concluded that the patient's ILD is without cause.


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