HRCT imaging of pulmonary fibrosis

HRCT is the non-invasive, gold-standard diagnostic tool for fibrotic ILDs1,2

ILD patients with the HRCT scans in their hands.

High-resolution computed tomography (HRCT) is essential for reaching accurate diagnoses of pulmonary fibrosis in ILDs, as well as assessing lesions, monitoring changes, screening for complications, and assessing prognosis.3

Detecting pulmonary fibrosis in ILDs is not always straightforward

The heterogeneity and unpredictability of ILDs can make pulmonary fibrosis a challenge to detect, often leading to a delayed diagnosis.4–7


Improve your ability to diagnose fibrotic ILDs. This atlas can assist you through the process of diagnosing an ILD, helping you recognize key clues and characteristics on chest HRCT and histopathology cuts from surgical lung biopsy.

4 imagining scans, representing fibrotic ILDs and characteristic for them lung pathologies.




  • Clustered cystic airspaces with well defined walls, measuring 2–10 mm in diameter, sometimes reaching 25 mm, usually in subpleural regions

Associated signs with honeycombing

  • Intraocular reticulation

  • Traction bronchiectasis and bronchiolectasis

  • Loss of lobar volume

  • Fissured distortion

Example of ILD Honeycombing in HRCT

Subpleural honeycombing forming several layers of cysts in a 73-year-old man with UIP.



  • Abnormal and irregular dilation of the bronchi/bronchioles due to respiratory tract inflammation (sometimes reversible) or pulmonary fibrosis

  • On a HRCT scan, it appears as an increase in the calibre of the distal respiratory tract (no reduction in the diameter peripherally, visibility in the subpleural lung at least 20 mm from the pleura)

  • On the scan, they present as tubular or cyctic air spaces depending on the orientation of the bronchi in the cross-section

  • Differentiating between traction bronchiectasis and honeycomb is sometimes difficult on axial cross-sections. Sagittal or coronal cross-sections and the minIP are usual

Diagnosistic orientation

  • Traction bronchiectasis is associated with signs of fibrosis

Traction bronchiec bronchiol scan

72-year-old man with UIP. HRCT shows diffuse reticulations, and traction bronchiectasis and bronchiolectasis.


Example of IPF UIP pattern on HRCT

ATS/ERS/JRS/ALAT guidelines recommend that IPF can be confidently diagnosed if the clinical evaluation of the patient points to IPF and the HRCT shows a definite or probable pattern of UIP (conditional biopsy recommended)2

Why is early screening and diagnosis of IPF with HRCT important?


Example of cHP pattern on HRCT

Subpleural reticular thickening, air trapping and traction bronchiectasis

Understanding the impact of cHP on patients?


Example of sarcoidosis-associated interstitial lung disease pattern on HRC

How does sarcoidosis-associated interstitial lung disease impact patients?



Example of iNSIP pattern on HRCT

Ground-glass opacity, subpleural sparing and traction bronchiectasis

Find out more about how iNSIP can affect patients’ lives

Accurate HRCT interpretation is key to help support patients with fibrotic ILDs

  • ALAT, Latin American Thoracic Society; ATS, American Thoracic Society; ERS, European Respiratory Society; HRCT, high-resolution computed tomography; ILD, interstitial lung disease; iNSIP, idiopathic non-specific interstitial pneumonia; IPF, idiopathic pulmonary fibrosis; JRS, Japanese Respiratory Society; UIP, usual interstitial pneumonia.

  1. Chowaniec M, Skoczyńska M, Sokolik R, Wiland P. Interstitial lung disease in systemic sclerosis: challenges in early diagnosis and management. Reumatologia. 2018;56(4):249–254.

  2. Raghu G, Remy-Jardin M, Myers JL, et al; on behalf of the ATS/ERS/JRS/ALAT. Diagnosis of Idiopathic Pulmonary Fibrosis. An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline. Am J Respir Crit Care Med. 2018;198(5):e44–e68.

  3. Brauner M, et al. Imagerie des pneumopathies infiltrantes diffuses. Press Med. 2010;39:73–84.
  4. Wells AU, Brown KK, Flaherty KR, et al. What’s in a name? That which we call IPF, by any other name would act the same. Eur Respir J. 2018;51(5):1800692.
  5. Wijsenbeek MS, Kreuter M, Olson A, et al. Progressive fibrosing interstitial lung diseases: current practice in diagnosis and management. Curr Med Res Opin. 2019:1–10.
  6. Gulati M. Diagnostic assessment of patients with interstitial lung disease. Prim Care Respir J. 2011;20:120–127.
  7. Greiffo FR, Eickelberg O, Fernandez IE. Systems medicine advances in interstitial lung disease. Eur Respir Rev. 2017;26:170021.
  8. Chaudhuri N, Spencer L, Greaves M, et al. A Review of the Multidisciplinary Diagnosis of Interstitial Lung Diseases: A Retrospective Analysis in a Single UK Specialist Centre. J Clin Med. 2016;5(66):1–9.
  9. Cottin V, Hirani N, Hotchkin D, et al. Presentation, diagnosis and clinical course of the spectrum of progressive-fibrosing interstitial lung diseases. Eur Respir Rev. 2018;27(150):180076.
  10. Cottin V, Brown KK. Interstitial lung disease associated with systemic sclerosis (SSc–ILD). Respir Res. 2019a;20(1):13.
  11. Wong AW, Ryerson C, Guler S. Progression of fibrosing interstitial lung disease. Respir Res. 2020:29;21(1):32.
  12. Flaherty KR, Brown KK, Wells AU, et al. Design of the PF-ILD trial: A double-blind, randomised, placebo-controlled phase III trial of nintedanib in patients with progressive fibrosing interstitial lung disease. BMJ Open Resp Res. 2017;4(1):e000212.
  13. Theodore AC, Tseng C-H, Li N, Elashoff RM, Tashkin DP. Correlation of cough with disease activity and treatment with cyclophosphamide in scleroderma interstitial lung disease: findings from the Scleroderma Lung Study. Chest. 2012;142(3):614–621.
  14. Hoffmann-Vold AM, Fretheim H, Halse AK, et al. Tracking impact of interstitial lung disease in systemic sclerosis in a complete nationwide cohort. Am J Respir Crit Care Med. 2019;200:1258–1266. 
  15. Hoffmann-Vold AM, Maher TM, Philpot EE, et al. The identification and management of interstitial lung disease in systemic sclerosis: evidence-based European consensus statements. The Lancet Rheumatology. 2020b;2: e71–e83.
  16. Asano Y, Jinnin M, Kawaguchi Y, et al. Diagnostic criteria, severity classification and guidelines of systemic sclerosis: Guideline of SSc. J Dermatol. 2018;45, 633–691.

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