0:01

So this is just a classic case of UIP.

0:04

I've thrown you some curve balls.

0:05

So I wanted to make sure that you've seen at least one

0:07

of these classic cases where it's just definitive UIP.

0:10

So we look at these actual images. Clearly it's peripheral.

0:13

Clearly bas are predominant in terms of

0:16

the superior inferior distribution, classic subpleural,

0:19

honeycombing, both in the lower lobes,

0:22

mid aspect lungs, upper lobes.

0:24

There are no other findings

0:25

that suggest an alternative diagnosis.

0:27

This is UIP, take it to the bank.

0:30

Something that with these patients

0:31

with significant pulmonary fibrosis,

0:33

especially if you have some fibrosis in the upper lobes,

0:36

you can get associated tracheal dilation.

0:39

I like to think of it as like traction tracheitis.

0:42

That's not a real term. Again, um, not a real term, right?

0:45

But this, this is the way I think of it.

0:47

So the fibrosis is chronically tugging on things

0:50

or making it harder to make the, the lungs inflate.

0:53

And so you really need tr have more negative, uh,

0:56

pressure in the pleural space

0:58

and that chronically will make the trachea

1:00

or mediastinal structures bigger.

1:02

That's just what I'm thinking.

1:03

In my mind, that's my explanatory model

1:04

or mnemonic of things to not miss in the mediastinum.

1:09

So, uh, if you see tracheal dilation,

1:12

you shouldn't be thinking about tracheal broncho magaly

1:15

or MOC c**n or anything like that.

1:16

If you have significant pulmonary fibrosis,

1:18

it's almost a surely secondary

1:19

to the patient's significant pulmonary fibrosis

1:22

as we see in this case.