Does this patient have a UIP pattern?
While the honeycombing and traction bronchiectasis are in keeping with a UIP pattern, the extensive ground gas opacity and gas trapping is not. These changes do not meet HRCT criteria for UIP.
What additional history is needed?
Any industrial or other exposures.
This patient had kept pigeons for many years, does this help with the diagnosis?
Yes, with this history bird fancier's disease (chronic hypersensitivity pneumonitis) is the most likely diagnosis.
Reticular opacity and honeycombing in a mainly basal and peripheral distribution. Traction bronchiectasis in the bases. Widespread ground glass opacity. Gas trapping on expiratory images. Emphysematous changes at the lung apices.
No pleural effusion. No lymphadenopathy.