Clinical and radiological manifestations of pulmonary fibrosis

Clinical and radiological manifestations of pulmonary fibrosis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinical and radiological manifestations of pulmonary fibrosis Mohamad Homam AL-jomaat, Ali Al Jbawi, Molham Al-Fandi, Khalid Khattab This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6984095/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Pulmonary fibrosis is a progressive lung disease characterized by scarring of lung tissue, leading to impaired respiratory function. Accurate radiological assessment is crucial for diagnosis and management. Methods and Materials: This retrospective study included 750 patients diagnosed with pulmonary fibrosis. All patients underwent chest X-rays and high-resolution computed tomography (HRCT) scans. Data on clinical features, smoking status, and radiological findings were collected and analyzed. Results: Among the studied patients, 75% were male and 25% female, with 83% being smokers. The main causes identified included sarcoidosis (25%), connective tissue diseases (23%), and chronic diseases (22%). Chest X-rays showed abnormalities in 60% of cases, while HRCT detected fibrosis signs in 100% of cases. The lower lobes were most commonly affected (75%), and high-resolution CT demonstrated superior sensitivity compared to standard CT. Complications such as pulmonary hypertension (30%) and fungal infections (45%) were also observed. Conclusion: High-resolution CT is the gold standard for diagnosing pulmonary fibrosis, offering superior detection rates compared to standard imaging. Smoking remains a significant risk factor associated with disease severity. Pulmonology Pulmonary fibrosis high-resolution CT smoking radiological findings Introduction Pulmonary fibrosis is a chronic interstitial lung disease characterized by progressive alterations in lung architecture, with the development of abnormal fibrotic tissue in the alveolar walls and interstitium, leading to impaired gas exchange and gradual respiratory failure [ 1 ]. Idiopathic Pulmonary Fibrosis (IPF) represents the most common and severe subtype of pulmonary fibrosis, predominantly affecting males over the age of 50, with an average survival of 3 to 5 years after diagnosis [ 2 ]. The initial clinical symptoms are often nonspecific, with patients typically presenting with exertional dyspnea and chronic dry cough. In some cases, these symptoms may be accompanied by general fatigue, weight loss, and digital clubbing [ 3 ]. Radiological evaluation is crucial in the diagnostic process, particularly with the use of high-resolution computed tomography (HRCT), which reveals characteristic features such as subpleural reticular opacities, traction bronchiectasis, and honeycombing patterns [ 4 ]. While standard chest radiography may show basal reticular infiltrates, HRCT demonstrates significantly higher sensitivity and specificity and is considered the radiological gold standard for diagnosing IPF, especially when lung biopsy is not indicated [ 5 ]. Recent studies emphasize the importance of integrating clinical, radiological, and pulmonary function data within a multidisciplinary diagnostic discussion that includes pulmonologists, radiologists, and pathologists [ 6 ]. This study aims to highlight the key clinical and radiological features associated with pulmonary fibrosis and analyze their correlation with disease severity to improve early diagnosis and optimize patient management. Methods and Materials This retrospective cross-sectional study was conducted at the Department of Pulmonology at Al-Mouwasat University Hospital, affiliated with Damascus University. It included patients diagnosed with pulmonary fibrosis during the period from January 1, 2020, to December 31, 2024. Data were collected from both paper and electronic medical records and included demographic variables (age, sex), clinical data (symptoms, smoking history, comorbidities), pulmonary function test results (such as FVC and DLCO), and radiological findings documented via high-resolution computed tomography (HRCT). Radiological patterns were classified according to the criteria established by the American Thoracic Society (ATS) and the European Respiratory Society (ERS). All patients with a confirmed diagnosis of pulmonary fibrosis and complete data were included. Ethical Approval: The study protocol was approved by the Ethics Committee of Al-Mouwasat University Hospital, Damascus University. Patient confidentiality and data privacy were strictly maintained throughout all stages of data collection and analysis. As this was a retrospective study involving no direct clinical interventions or experiments on patients, the requirement for informed consent was waived, in accordance with institutional ethical guidelines. Statistical Analysis: Data were entered and analyzed using the Statistical Package for the Social Sciences (SPSS), version 26. Descriptive and analytical statistical methods were applied. Categorical variables (such as gender, symptoms, and radiological patterns) were expressed as frequencies and percentages, Associations between categorical variables were assessed using the Chi-square test, and a p-value < 0.05 was considered statistically significant. Results This study included 750 patients diagnosed with pulmonary fibrosis. The majority of cases were male, accounting for 75% (563 patients), while females represented 25% (187 patients). A high proportion of patients were smokers, with 83% (623 patients) being active smokers compared to 17% (127 patients) non-smokers. Regarding potential predisposing or underlying causes of fibrosis, sarcoidosis was the most commonly identified cause in 25% of patients (188), followed by connective tissue diseases in 23% (173), and chronic diseases in 22% (165). Idiopathic pneumonia was found in 15% (113), interstitial pneumonia in 10% (75), and unknown causes in 5% (38) of cases. All patients underwent both chest X-rays and CT imaging (100%). Positive findings were observed on chest X-rays in 60% (450 patients), while 40% (300) appeared normal. High-resolution computed tomography (HRCT) revealed pathological findings in all patients, whereas standard helical CT scans identified abnormalities in only 77% (578 patients), highlighting the superior diagnostic sensitivity of HRCT. Most CT scans were performed without contrast; 27% of patients (203) underwent both pre- and post-contrast imaging, and no significant diagnostic advantage was found with contrast administration. In terms of lung involvement, fibrosis was observed in the right lung in 35% of patients (263), in the left lung in 25% (188), and in both lungs in 40% (299). Lower lobes were predominantly affected (75%, 563 patients), compared to the upper lobes (25%, 187 patients). Additional findings on HRCT included bilateral pleural effusion in 25% (188 patients), unilateral effusion in 15% (113), pulmonary consolidation in 13% (98), fissure thickening in 15% (113), and atelectatic foci in 22% (165 patients). Slice thickness was directly associated with the detection rate of radiologic abnormalities: 55% of findings were visible on 5 mm slices (413 patients), 75% on 2–3 mm slices (563 patients), and 100% on 1 mm slices (750 patients). Prior to the development of hallmark fibrosis signs, HRCT demonstrated honeycombing in 32% (240 patients), reticular patterns in 32% (240), normal-appearing lungs in 26% (195), and bronchiectasis in 10% (75). A clear association was found between smoking and fibrosis severity. Heavy smokers comprised 76% of patients (570), while 7% (53) had passive exposure, and 17% (127) were non-smokers. Reticular infiltrates were present in 78% of patients (585). When comparing conventional CT with HRCT, normal lung findings were reported in 26% (195 patients) on conventional CT, versus only 3% (23 patients) on HRCT. Bronchiectasis appeared in 10% on standard CT (75), increasing to 45% (338) on HRCT. Reticular infiltrates were seen in 32% (240) on conventional CT, and in 66% (495) on HRCT. Honeycombing was observed in 32% (240) on conventional CT and in 76% (570) on HRCT. Reviewing medical histories revealed predisposing conditions: previous chemical exposure was noted in 40% (300 patients), chronic kidney disease in 24% (180), lung cancer in 11% (83), prior pneumonia in 7% (53), and cardiac conditions in 3% (23). The distribution of radiologic findings on CT showed subpleural fibrosis in 35% (263 patients), basal predominance in 20% (150), perihilar involvement in 10% (75), mosaic attenuation in 5% (38), and small nodular lesions in 35% (263). Pulmonary complications associated with fibrosis included pulmonary hypertension in 30% (225 patients), aspergillosis in 45% (338), and obstructive sleep apnea in 25% (188). Extrapulmonary complications included gastroesophageal reflux disease in 27% (203), coronary artery disease in 23% (173), heart failure in 35% (263), and thromboembolic disease in 25% (188 patients). Discussion The results of this study, which included 750 patients with pulmonary fibrosis, show notable consistency with global literature. The majority of patients were male (75%), which aligns with international studies indicating that idiopathic pulmonary fibrosis (IPF) predominantly affects males, with reported rates between 65–70% [7]. The high prevalence of smoking among patients (83%) also corresponds with global evidence identifying smoking as a major risk factor for the development of pulmonary fibrosis, particularly in idiopathic cases [8]. Regarding predisposing factors, sarcoidosis accounted for 25% of cases, which closely matches international reports stating that 20–30% of sarcoidosis cases may progress to fibrotic lung disease [9]. Connective tissue diseases were present in 23% of cases, consistent with studies linking systemic sclerosis and lupus erythematosus to interstitial lung fibrosis [10]. Radiologically, this study confirmed that high-resolution computed tomography (HRCT) detected fibrotic changes in 100% of patients, compared to only 77% in conventional helical CT and 60% on plain chest radiographs. These results align with current American and European respiratory society guidelines, which consider HRCT the gold standard imaging modality for diagnosing pulmonary fibrosis [11]. Moreover, the accuracy of detection increased significantly with thinner CT slice thickness—up to 1 mm—supporting similar findings in other radiological studies [12]. As for radiologic patterns, honeycombing was observed in 76% of patients using HRCT, compared to only 32% on standard CT scans. This finding is in agreement with multiple studies that report the classic usual interstitial pneumonia (UIP) pattern, including honeycombing, in approximately 60–70% of IPF patients [13]. Reticular infiltrates and bronchiectasis were also more clearly visualized on HRCT, highlighting its role in evaluating disease severity and radiological subtype. Concerning complications, 30% of patients exhibited pulmonary hypertension, a frequent comorbidity also documented in international literature with a reported prevalence of 30–40% in advanced fibrotic lung disease [14]. Fungal infection, particularly aspergillosis, was noted in 45% of cases—a relatively high proportion, but potentially explained by the presence of fibrocystic cavities that facilitate fungal colonization. Other studies have reported fungal co-infection rates ranging from 10–30% [15]. In addition, comorbidities such as chronic kidney disease, previous chemical exposure, and a history of lung cancer were documented in a notable percentage of patients. These findings support the multifactorial pathogenesis of pulmonary fibrosis, as outlined in large-scale clinical and epidemiological research [16]. Conclusion This study demonstrated that high-resolution computed tomography (HRCT) is the most accurate and sensitive radiological modality for detecting pulmonary fibrosis compared to plain radiographs or conventional CT scans. HRCT showed superior capability in identifying hallmark radiologic signs such as honeycombing, bronchiectasis, and reticular infiltrates. The slice thickness was found to play a critical role in diagnostic accuracy, and fibrotic involvement was more pronounced in the lower lobes and subpleural and basal regions. A strong association was observed between smoking and pulmonary fibrosis, along with frequent co-occurrence of significant pulmonary and extrapulmonary complications, including pulmonary hypertension, fungal infections, and heart failure. These findings highlight the importance of routinely employing HRCT in the assessment of pulmonary fibrosis patients and underscore the need to evaluate predisposing risk factors and complications to guide appropriate management. Declarations Acknowledgments: The authors gratefully acknowledge the invaluable support provided by the staff of Al-Mouwasat University Hospital. Their cooperation in granting access to medical archives and their ongoing assistance were essential for the successful completion of this study. Funding Statement: This work was carried out without any financial support from governmental bodies, private industry, or non-profit institutions. Conflict of Interest: The authors affirm that there are no actual or potential conflicts of interest associated with this research. Data Availability: The datasets generated and analyzed during this study are not publicly available due to institutional confidentiality policies but may be obtained from the corresponding author upon reasonable and approved request. Ethical Approval: This study was conducted in accordance with the ethical standards of the Al-Mouwasat University Hospital Research Ethics Committee. Formal approval was granted under protocol number 1981/MO/2025. Given the retrospective design and the anonymized nature of the data, individual patient consent was not required. References Raghu G, Weycker D, Edelsberg J, Bradford WZ, Oster G (2006) Incidence and prevalence of idiopathic pulmonary fibrosis. Am J Respir Crit Care Med 174(7):810–816 Lederer DJ, Martinez FJ (2018) Idiopathic Pulmonary Fibrosis. N Engl J Med 378(19):1811–1823 King TE, Pardo A, Selman M (2011) Idiopathic pulmonary fibrosis. Lancet 378(9807):1949–1961 Lynch DA, Sverzellati N, Travis WD et al (2018) Diagnostic criteria for idiopathic pulmonary fibrosis: A Fleischner Society White Paper. Lancet Respir Med 6(2):138–153 Sverzellati N (2013) Highlights of HRCT imaging in IPF. Respir Res 14(Suppl 1):S3 Flaherty KR, Wells AU, Cottin V et al (2019) NACIP: a multidisciplinary approach to IPF diagnosis. Eur Respir J 53(4):1802135 Raghu G, Remy-Jardin M, Myers JL, Richeldi L, Ryerson CJ, Lederer DJ et al (2018) Diagnosis of Idiopathic Pulmonary Fibrosis. An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline. Am J Respir Crit Care Med 198(5):e44–e68 Lynch DA, Sverzellati N, Travis WD, Brown KK, Colby TV, Galvin JR et al (2018) Diagnostic criteria for idiopathic pulmonary fibrosis: A Fleischner Society White Paper. Lancet Respir Med 6(2):138–153 Sverzellati N, Wells AU, Tomassetti S, Devaraj A, Poletti V (2015) Use of CT in establishing diagnosis and prognosis of idiopathic pulmonary fibrosis. Radiology 275(2):567–578 Kim DS, Collard HR, King TE Jr (2006) Classification and natural history of the idiopathic interstitial pneumonias. Proc Am Thorac Soc 3(4):285–292 Silva CIS, Müller NL, Lynch DA, Curran-Everett D, Brown KK, Lee KS et al (2008) Usual interstitial pneumonia: patterns of disease and prognosis. Radiology 246(2):935–944 Flaherty KR, King TE Jr, Raghu G, Lynch JP 3rd, Colby TV, Travis WD et al (2004) Idiopathic interstitial pneumonia: effect of a multidisciplinary approach to diagnosis. Am J Respir Crit Care Med 170(8):904–910 Johannson KA, Enomoto N, Vittinghoff E, De Sadeleer LJ, Wuyts WA, Azuma A et al (2017) Predicting survival in idiopathic pulmonary fibrosis: a systematic review and meta-analysis. Eur Respir J 50(2):1700079 Walsh SLF, Calandriello L, Devaraj A, Wells AU, Hansell DM (2016) Interobserver agreement for the ATS/ERS/JRS/ALAT criteria for a UIP pattern on CT. Thorax 71(1):45–51 Wells AU, Desai SR, Rubens MB, Goh NSL, Cramer D, Nicholson AG et al (2003) Idiopathic pulmonary fibrosis: a composite physiologic index derived from disease extent observed by computed tomography. Am J Respir Crit Care Med 167(7):962–969 Hansell DM, Bankier AA, MacMahon H, McLoud TC, Müller NL, Remy J (2008) Fleischner Society: glossary of terms for thoracic imaging. Radiology 246(3):697–722 Additional Declarations The authors declare potential competing interests as follows: no Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Idiopathic Pulmonary Fibrosis (IPF) represents the most common and severe subtype of pulmonary fibrosis, predominantly affecting males over the age of 50, with an average survival of 3 to 5 years after diagnosis [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe initial clinical symptoms are often nonspecific, with patients typically presenting with exertional dyspnea and chronic dry cough. In some cases, these symptoms may be accompanied by general fatigue, weight loss, and digital clubbing [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Radiological evaluation is crucial in the diagnostic process, particularly with the use of high-resolution computed tomography (HRCT), which reveals characteristic features such as subpleural reticular opacities, traction bronchiectasis, and honeycombing patterns [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWhile standard chest radiography may show basal reticular infiltrates, HRCT demonstrates significantly higher sensitivity and specificity and is considered the radiological gold standard for diagnosing IPF, especially when lung biopsy is not indicated [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Recent studies emphasize the importance of integrating clinical, radiological, and pulmonary function data within a multidisciplinary diagnostic discussion that includes pulmonologists, radiologists, and pathologists [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study aims to highlight the key clinical and radiological features associated with pulmonary fibrosis and analyze their correlation with disease severity to improve early diagnosis and optimize patient management.\u003c/p\u003e"},{"header":"Methods and Materials","content":"\u003cp\u003eThis retrospective cross-sectional study was conducted at the Department of Pulmonology at Al-Mouwasat University Hospital, affiliated with Damascus University. It included patients diagnosed with pulmonary fibrosis during the period from January 1, 2020, to December 31, 2024.\u003c/p\u003e \u003cp\u003eData were collected from both paper and electronic medical records and included demographic variables (age, sex), clinical data (symptoms, smoking history, comorbidities), pulmonary function test results (such as FVC and DLCO), and radiological findings documented via high-resolution computed tomography (HRCT).\u003c/p\u003e \u003cp\u003eRadiological patterns were classified according to the criteria established by the American Thoracic Society (ATS) and the European Respiratory Society (ERS).\u003c/p\u003e \u003cp\u003eAll patients with a confirmed diagnosis of pulmonary fibrosis and complete data were included.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEthical Approval:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocol was approved by the Ethics Committee of Al-Mouwasat University Hospital, Damascus University.\u003c/p\u003e\n\u003cp\u003ePatient confidentiality and data privacy were strictly maintained throughout all stages of data collection and analysis.\u003c/p\u003e\n\u003cp\u003eAs this was a retrospective study involving no direct clinical interventions or experiments on patients, the requirement for informed consent was waived, in accordance with institutional ethical guidelines.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were entered and analyzed using the Statistical Package for the Social Sciences (SPSS), version 26.\u003c/p\u003e\n\u003cp\u003eDescriptive and analytical statistical methods were applied. Categorical variables (such as gender, symptoms, and radiological patterns) were expressed as frequencies and percentages,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAssociations between categorical variables were assessed using the Chi-square test, and a p-value \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThis study included 750 patients diagnosed with pulmonary fibrosis. The majority of cases were male, accounting for 75% (563 patients), while females represented 25% (187 patients). A high proportion of patients were smokers, with 83% (623 patients) being active smokers compared to 17% (127 patients) non-smokers.\u003c/p\u003e\n\u003cp\u003eRegarding potential predisposing or underlying causes of fibrosis, sarcoidosis was the most commonly identified cause in 25% of patients (188), followed by connective tissue diseases in 23% (173), and chronic diseases in 22% (165). Idiopathic pneumonia was found in 15% (113), interstitial pneumonia in 10% (75), and unknown causes in 5% (38) of cases.\u003c/p\u003e\n\u003cp\u003eAll patients underwent both chest X-rays and CT imaging (100%). Positive findings were observed on chest X-rays in 60% (450 patients), while 40% (300) appeared normal. High-resolution computed tomography (HRCT) revealed pathological findings in all patients, whereas standard helical CT scans identified abnormalities in only 77% (578 patients), highlighting the superior diagnostic sensitivity of HRCT.\u003c/p\u003e\n\u003cp\u003eMost CT scans were performed without contrast; 27% of patients (203) underwent both pre- and post-contrast imaging, and no significant diagnostic advantage was found with contrast administration.\u003c/p\u003e\n\u003cp\u003eIn terms of lung involvement, fibrosis was observed in the right lung in 35% of patients (263), in the left lung in 25% (188), and in both lungs in 40% (299). Lower lobes were predominantly affected (75%, 563 patients), compared to the upper lobes (25%, 187 patients).\u003c/p\u003e\n\u003cp\u003eAdditional findings on HRCT included bilateral pleural effusion in 25% (188 patients), unilateral effusion in 15% (113), pulmonary consolidation in 13% (98), fissure thickening in 15% (113), and atelectatic foci in 22% (165 patients).\u003c/p\u003e\n\u003cp\u003eSlice thickness was directly associated with the detection rate of radiologic abnormalities: 55% of findings were visible on 5 mm slices (413 patients), 75% on 2–3 mm slices (563 patients), and 100% on 1 mm slices (750 patients).\u003c/p\u003e\n\u003cp\u003ePrior to the development of hallmark fibrosis signs, HRCT demonstrated honeycombing in 32% (240 patients), reticular patterns in 32% (240), normal-appearing lungs in 26% (195), and bronchiectasis in 10% (75).\u003c/p\u003e\n\u003cp\u003eA clear association was found between smoking and fibrosis severity. Heavy smokers comprised 76% of patients (570), while 7% (53) had passive exposure, and 17% (127) were non-smokers. Reticular infiltrates were present in 78% of patients (585).\u003c/p\u003e\n\u003cp\u003eWhen comparing conventional CT with HRCT, normal lung findings were reported in 26% (195 patients) on conventional CT, versus only 3% (23 patients) on HRCT. Bronchiectasis appeared in 10% on standard CT (75), increasing to 45% (338) on HRCT. Reticular infiltrates were seen in 32% (240) on conventional CT, and in 66% (495) on HRCT. Honeycombing was observed in 32% (240) on conventional CT and in 76% (570) on HRCT.\u003c/p\u003e\n\u003cp\u003eReviewing medical histories revealed predisposing conditions: previous chemical exposure was noted in 40% (300 patients), chronic kidney disease in 24% (180), lung cancer in 11% (83), prior pneumonia in 7% (53), and cardiac conditions in 3% (23).\u003c/p\u003e\n\u003cp\u003eThe distribution of radiologic findings on CT showed subpleural fibrosis in 35% (263 patients), basal predominance in 20% (150), perihilar involvement in 10% (75), mosaic attenuation in 5% (38), and small nodular lesions in 35% (263).\u003c/p\u003e\n\u003cp\u003ePulmonary complications associated with fibrosis included pulmonary hypertension in 30% (225 patients), aspergillosis in 45% (338), and obstructive sleep apnea in 25% (188). Extrapulmonary complications included gastroesophageal reflux disease in 27% (203), coronary artery disease in 23% (173), heart failure in 35% (263), and thromboembolic disease in 25% (188 patients).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe results of this study, which included 750 patients with pulmonary fibrosis, show notable consistency with global literature. The majority of patients were male (75%), which aligns with international studies indicating that idiopathic pulmonary fibrosis (IPF) predominantly affects males, with reported rates between 65–70% [7]. The high prevalence of smoking among patients (83%) also corresponds with global evidence identifying smoking as a major risk factor for the development of pulmonary fibrosis, particularly in idiopathic cases [8].\u003c/p\u003e\n\u003cp\u003eRegarding predisposing factors, sarcoidosis accounted for 25% of cases, which closely matches international reports stating that 20–30% of sarcoidosis cases may progress to fibrotic lung disease [9]. Connective tissue diseases were present in 23% of cases, consistent with studies linking systemic sclerosis and lupus erythematosus to interstitial lung fibrosis [10].\u003c/p\u003e\n\u003cp\u003eRadiologically, this study confirmed that high-resolution computed tomography (HRCT) detected fibrotic changes in 100% of patients, compared to only 77% in conventional helical CT and 60% on plain chest radiographs. These results align with current American and European respiratory society guidelines, which consider HRCT the gold standard imaging modality for diagnosing pulmonary fibrosis [11]. Moreover, the accuracy of detection increased significantly with thinner CT slice thickness—up to 1 mm—supporting similar findings in other radiological studies [12].\u003c/p\u003e\n\u003cp\u003eAs for radiologic patterns, honeycombing was observed in 76% of patients using HRCT, compared to only 32% on standard CT scans. This finding is in agreement with multiple studies that report the classic usual interstitial pneumonia (UIP) pattern, including honeycombing, in approximately 60–70% of IPF patients [13]. Reticular infiltrates and bronchiectasis were also more clearly visualized on HRCT, highlighting its role in evaluating disease severity and radiological subtype.\u003c/p\u003e\n\u003cp\u003eConcerning complications, 30% of patients exhibited pulmonary hypertension, a frequent comorbidity also documented in international literature with a reported prevalence of 30–40% in advanced fibrotic lung disease [14]. Fungal infection, particularly aspergillosis, was noted in 45% of cases—a relatively high proportion, but potentially explained by the presence of fibrocystic cavities that facilitate fungal colonization. Other studies have reported fungal co-infection rates ranging from 10–30% [15].\u003c/p\u003e\n\u003cp\u003eIn addition, comorbidities such as chronic kidney disease, previous chemical exposure, and a history of lung cancer were documented in a notable percentage of patients. These findings support the multifactorial pathogenesis of pulmonary fibrosis, as outlined in large-scale clinical and epidemiological research [16].\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study demonstrated that high-resolution computed tomography (HRCT) is the most accurate and sensitive radiological modality for detecting pulmonary fibrosis compared to plain radiographs or conventional CT scans. HRCT showed superior capability in identifying hallmark radiologic signs such as honeycombing, bronchiectasis, and reticular infiltrates. The slice thickness was found to play a critical role in diagnostic accuracy, and fibrotic involvement was more pronounced in the lower lobes and subpleural and basal regions. A strong association was observed between smoking and pulmonary fibrosis, along with frequent co-occurrence of significant pulmonary and extrapulmonary complications, including pulmonary hypertension, fungal infections, and heart failure. These findings highlight the importance of routinely employing HRCT in the assessment of pulmonary fibrosis patients and underscore the need to evaluate predisposing risk factors and complications to guide appropriate management.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors gratefully acknowledge the invaluable support provided by the staff of Al-Mouwasat University Hospital. Their cooperation in granting access to medical archives and their ongoing assistance were essential for the successful completion of this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Statement:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was carried out without any financial support from governmental bodies, private industry, or non-profit institutions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors affirm that there are no actual or potential conflicts of interest associated with this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and analyzed during this study are not publicly available due to institutional confidentiality policies but may be obtained from the corresponding author upon reasonable and approved request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the ethical standards of the Al-Mouwasat University Hospital Research Ethics Committee. Formal approval was granted under protocol number 1981/MO/2025. Given the retrospective design and the anonymized nature of the data, individual patient consent was not required.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eRaghu G, Weycker D, Edelsberg J, Bradford WZ, Oster G (2006) Incidence and prevalence of idiopathic pulmonary fibrosis. Am J Respir Crit Care Med 174(7):810\u0026ndash;816\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLederer DJ, Martinez FJ (2018) Idiopathic Pulmonary Fibrosis. N Engl J Med 378(19):1811\u0026ndash;1823\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKing TE, Pardo A, Selman M (2011) Idiopathic pulmonary fibrosis. Lancet 378(9807):1949\u0026ndash;1961\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLynch DA, Sverzellati N, Travis WD et al (2018) Diagnostic criteria for idiopathic pulmonary fibrosis: A Fleischner Society White Paper. Lancet Respir Med 6(2):138\u0026ndash;153\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSverzellati N (2013) Highlights of HRCT imaging in IPF. Respir Res 14(Suppl 1):S3\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFlaherty KR, Wells AU, Cottin V et al (2019) NACIP: a multidisciplinary approach to IPF diagnosis. Eur Respir J 53(4):1802135\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRaghu G, Remy-Jardin M, Myers JL, Richeldi L, Ryerson CJ, Lederer DJ et al (2018) Diagnosis of Idiopathic Pulmonary Fibrosis. An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline. Am J Respir Crit Care Med 198(5):e44\u0026ndash;e68\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLynch DA, Sverzellati N, Travis WD, Brown KK, Colby TV, Galvin JR et al (2018) Diagnostic criteria for idiopathic pulmonary fibrosis: A Fleischner Society White Paper. Lancet Respir Med 6(2):138\u0026ndash;153\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSverzellati N, Wells AU, Tomassetti S, Devaraj A, Poletti V (2015) Use of CT in establishing diagnosis and prognosis of idiopathic pulmonary fibrosis. Radiology 275(2):567\u0026ndash;578\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim DS, Collard HR, King TE Jr (2006) Classification and natural history of the idiopathic interstitial pneumonias. Proc Am Thorac Soc 3(4):285\u0026ndash;292\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSilva CIS, M\u0026uuml;ller NL, Lynch DA, Curran-Everett D, Brown KK, Lee KS et al (2008) Usual interstitial pneumonia: patterns of disease and prognosis. Radiology 246(2):935\u0026ndash;944\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFlaherty KR, King TE Jr, Raghu G, Lynch JP 3rd, Colby TV, Travis WD et al (2004) Idiopathic interstitial pneumonia: effect of a multidisciplinary approach to diagnosis. Am J Respir Crit Care Med 170(8):904\u0026ndash;910\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJohannson KA, Enomoto N, Vittinghoff E, De Sadeleer LJ, Wuyts WA, Azuma A et al (2017) Predicting survival in idiopathic pulmonary fibrosis: a systematic review and meta-analysis. Eur Respir J 50(2):1700079\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWalsh SLF, Calandriello L, Devaraj A, Wells AU, Hansell DM (2016) Interobserver agreement for the ATS/ERS/JRS/ALAT criteria for a UIP pattern on CT. Thorax 71(1):45\u0026ndash;51\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWells AU, Desai SR, Rubens MB, Goh NSL, Cramer D, Nicholson AG et al (2003) Idiopathic pulmonary fibrosis: a composite physiologic index derived from disease extent observed by computed tomography. Am J Respir Crit Care Med 167(7):962\u0026ndash;969\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHansell DM, Bankier AA, MacMahon H, McLoud TC, M\u0026uuml;ller NL, Remy J (2008) Fleischner Society: glossary of terms for thoracic imaging. Radiology 246(3):697\u0026ndash;722\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[{"identity":"1580f03b-0943-4bdc-81e3-be0d1542d04f","identifier":"10.13039/100016418","name":"B.K. Kee Foundation","awardNumber":"0507547152","order_by":0}],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Al-Sham Private University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Pulmonary fibrosis, high-resolution CT, smoking, radiological findings","lastPublishedDoi":"10.21203/rs.3.rs-6984095/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6984095/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Pulmonary fibrosis is a progressive lung disease characterized by scarring of lung tissue, leading to impaired respiratory function. Accurate radiological assessment is crucial for diagnosis and management.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods and Materials:\u003c/strong\u003e This retrospective study included 750 patients diagnosed with pulmonary fibrosis. All patients underwent chest X-rays and high-resolution computed tomography (HRCT) scans. Data on clinical features, smoking status, and radiological findings were collected and analyzed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Among the studied patients, 75% were male and 25% female, with 83% being smokers. The main causes identified included sarcoidosis (25%), connective tissue diseases (23%), and chronic diseases (22%). Chest X-rays showed abnormalities in 60% of cases, while HRCT detected fibrosis signs in 100% of cases. The lower lobes were most commonly affected (75%), and high-resolution CT demonstrated superior sensitivity compared to standard CT. Complications such as pulmonary hypertension (30%) and fungal infections (45%) were also observed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e High-resolution CT is the gold standard for diagnosing pulmonary fibrosis, offering superior detection rates compared to standard imaging. Smoking remains a significant risk factor associated with disease severity.\u003c/p\u003e","manuscriptTitle":"Clinical and radiological manifestations of pulmonary fibrosis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-27 09:48:32","doi":"10.21203/rs.3.rs-6984095/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"406670ee-7c3c-461f-b09f-aeca54822676","owner":[],"postedDate":"June 27th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":50643988,"name":"Pulmonology"}],"tags":[],"updatedAt":"2025-06-27T09:48:32+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-27 09:48:32","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6984095","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6984095","identity":"rs-6984095","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}