Radiological honeycombing: pitfalls in idiopathic pulmonary fibrosis diagnosis

ABSTRACT

Introduction

High-Resolution Computed Tomography (HRCT) plays a pivotal role in the diagnosis of Idiopathic Pulmonary Fibrosis (IPF). First, it establishes the presence of lung fibrosis. Second, it allows the recognition of specific patterns, namely typical and probable Usual Interstitial Pneumonia (UIP) pattern obviating the need for tissue confirmation in the appropriate clinical context.

Areas covered

Acknowledging the extreme versatility of modern radiology and the heavy burden of knowledge the modern radiologist has to cope with, this review addresses the diagnostic pitfalls of honeycombing in IPF diagnosis. This review focuses on two areas: i) when honeycombing is actually present but there are other findings that should raise suspicion of an alternative diagnosis and ii) when honeycombing is misdiagnosed, focusing on the commonest radiographic patterns that are responsible for this confusion.

Expert opinion

It is pivotal to establish the actual presence of honeycombing. Even then, the distribution of honeycombing or the presence of other findings could be suggestive of alternative diagnoses. Reviewing older images can be extremely helpful in reaching the correct diagnosis.

KEYWORDS:

• High-Resolution Computed Tomography (HRCT)
• Usual Interstitial Pneumonia (UIP)
• Idiopathic Pulmonary Fibrosis (IPF)
• fibrotic interstitial lung disease
• honeycombing

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.