Cross sectional imaging of pulmonary fibrosis translating pathology into radiology


      • Fibroblast foci and honeycombing are hallmarks for pathology diagnosis of UIP but there is overlap with ACF and fibrotic NSIP.
      • UIP demonstrates normal tissue adjacent to fibrosis and traction bronchiolectasis and honeycombing on same image.
      • NSIP demonstrates homogeneous fibrosis. Geographic and temporal heterogeneity, honeycombing, and fibroblastic foci are usually absent.
      • ACF demonstrate fibrotic changes following the bronchovascular bundles. The ACF and bronchioloitis cause air-trapping.


      There are three major pathologic patterns of pulmonary fibrosis; usual interstitial pneumonia (UIP), nonspecific interstitial pneumonia (NSIP) and airway-centered fibrosis (ACF). These pathologic patterns correspond with radiographic patterns of UIP, NSIP, and chronic hypersensitivity pneumonitis (CHP). Previous studies have demonstrated that the radiologic diagnosis is correct approximately 50% of the time for these fibrotic lung diseases. Understanding the microscopic pathologic patterns that are recapitulated at a macroscopic level in the high resolution CT scan is key to radiologists' ability to correctly diagnose pulmonary fibrosis and thus improve patient outcomes with early diagnosis and avoidance of biopsy. We investigate the similarities between the pathology and radiology features of UIP, NSIP, and ACF.


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