case_images: PMC10507213_01
case_images: Case 1: Nonspecific interstitial pneumonitis in a 51-year-old female with autoimmune features clinically.
  (A) Axial and (B) sagittal HRCT images demonstrate primarily ground glass opacities with minimal reticulation, predominantly subpleural in the distribution in the mid to lower lungs; note there is no bronchiectasis or honeycombing.
case_images: TORMJ-17-e187430642306150_F1.jpg
case_images: PMC10507213_01_TORMJ-17-e187430642306150_F1.jpg
case_images: F1
case_images: High-resolution computed tomography (HRCT) demonstrated a fibrotic nonspecific interstitial pneumonitis (NSIP) pattern, which may represent usual interstitial pneumonia (UIP) or NSIP histologically, including CTD-ILD (Fig. 1).
case_images: Lung wedge biopsy from the same patient in Fig. (1) from the right lower lobe. (A) and (B): Interstitial fibrosis has a predilection to the peripheral subpleural lung without the tissue-destructive scarring and honeycomb change characteristic for usual interstitial pneumonia (UIP) (magnification: 20x). (C): The accompanying inflammation is mild and composed of main lymphocytes with occasional lymphoid aggregates without secondary germinal centers (magnification: 40x). (D): Scattered subepithelial fibroblast foci (yellow arrow) are noted (magnification: 100x).
case_images: TORMJ-17-e187430642306150_F2.jpg
case_images: PMC10507213_01_TORMJ-17-e187430642306150_F2.jpg
case_images: F2
case_images: Subsequent surgical lung biopsy showed unclassi-fiable chronic interstitial pneumonia with fibrosis (Fig. 2).
case_images: PMC10507213_02
case_images: Case 2: Usual interstitial pneumonitis in a 71-year-old female with rheumatoid arthritis. (A) Axial and (B) coronal HRCT images demonstrate primarily subpleural honeycombing along both the costal and fissural pleural surfaces and mild biapical paraseptal emphysema.
case_images: TORMJ-17-e187430642306150_F3.jpg
case_images: PMC10507213_02_TORMJ-17-e187430642306150_F3.jpg
case_images: F3
case_images: TLC 4.62 liters (104% predicted), and DLCO 5.24 ml/min/mmHg (25% predicted), a Pseudonormalisation pattern with a severely impaired gas exchange that complemented the severe bilateral usual interstitial pneumonia pattern and emphysema on HRCT (Fig. 3) and co-morbid pulmonary hypertension contributing to her low DLCO. The consensus diagnosis at the multidisciplinary ILD conference was RA-associated UIP.
case_images: PMC10507213_03
case_images: Case 3: Temporal evolution of fibrotic nonspecific interstitial pneumonitis in a 66-year-old female with an overlap of primary Sjogren's syndrome and anti-synthetase syndrome. Axial HRCT images in (A) April 2017, (B) August 2017, and (C) September 2018 demonstrate basilar predominant ground glass opacities which evolved to include bronchiectasis and septal lines in the areas of ground glass four months, later indicating evolution from a primarily inflammatory process to fibrosis. 13 months later, there has been a further increase in the extent of disease with a larger percentage of abnormal lung and new ground glass opacity.
case_images: TORMJ-17-e187430642306150_F4.jpg
case_images: PMC10507213_03_TORMJ-17-e187430642306150_F4.jpg
case_images: F4
case_images: She received multiple courses of antibiotics without improvement, and HRCT revealed an NSIP pattern (Fig. 4).