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Objective: To identify the combination of clinical data and high resolution computed tomography (HRCT) features that best identified biopsy verified usual interstitial pneumonia (UIP)., Methods: The study included 91 patients with a tentative diagnosis of interstitial lung disease. All underwent clinical investigation, surgical lung biopsy and HRCT. Two independent readers assessed the HRCT images for the extent and pattern of abnormality. On the basis of the biopsy result the patients were categorized in three groups: 1) Usual interstitial pneumonia, 2) Other idiopathic interstitial pneumonias (IIPs) and hypersensitivity pneumonitis and 3) Other interstitial lung diseases. The diagnostic value of HRCT was investigated using likelihood ratio to estimate the post-test probability of UIP., Results: We found that UIP was associated with significantly higher scores for reticular pattern and for bronchiectasis than the remaining patients (p < 0.001). Moreover, these scores showed a steeper cranial-caudal increase in patients with histologically verified UIP than in the remaining patients (p < 0.001). UIP was associated with lower scores for ground glass opacities (p < 0.001). Using Bayes theorem and likelihood ratio estimation we found that UIP could be diagnosed with 90% certainty in patients 60 years or older and restrictive pattern in spirometry provided that HRCT demonstrated at least 15% reticular pattern and no ground glass opacities., Conclusion: In older patients with a restrictive spirometry in whom HRCT demonstrates a reticular pattern without ground glass opacities surgical lung biopsy is not warranted for the diagnosis of UIP., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Patients with common variable immunodeficiency (CVID) have impaired production of immunoglobulins and hence recurrent airway infections, which in turn may lead to radiological changes and impaired lung function. Uncertainty exists about the nature and frequency of the radiological and the physiological abnormalities, and how they relate to each other. We reassessed high resolution computed tomography (HRCT) images in 65 patients, reported results from previously measured lung function tests, and studied relations between radiology, function and clinical variables. Airway obstruction, ventilatory restriction and impaired gas diffusion was found in 40, 34 and 21% of the patients, respectively. HRCT abnormalities were present in 94% of the subjects, mild changes being the most common. Bronchial wall thickening, found in two thirds of the patients, was related to airway obstruction and impaired gas diffusion. Linear and/or irregular opacities, the most frequent interstitial abnormality, was related to impaired gas diffusion. Bronchiectasis was found in more than half, but only severe bronchiectasis was related to airway obstruction. Since bronchial wall thickening and linear and/or irregular opacities are both frequent and important determinants of impaired pulmonary function, more attention should be given to these features in the follow up of CVID patients.