Abstract Rationale Honeycombing on computed tomography (CT) chest imaging is often a sign of advanced lung disease which can lead to pulmonary hypertension (PH). The diagnosis of PH can significantly impact prognosis and management. While echocardiography is commonly performed during cardiology evaluation, the presence of right-sided heart changes should prompt further assessment for group 3 pulmonary hypertension. As treatment options for fibrotic lung disease and PH-ILD continue to expand, early recognition of patients at risk for group 3 PH is critical to ensure appropriate evaluation and management. Methods Natural language processing (NLP) was used to identify the term “honeycombing” in radiology narrative CT reports over a 12-month period. A retrospective chart review using EPIC assessed diagnostic and treatment patterns. Results Among 100 patients with honeycombing noted on CT imaging in 2024, 51 patients were evaluated by a pulmonologist. Of these, 75% (38/51) had also been seen by a cardiologist, and all 38 underwent echocardiography. Indirect signs of PH—such as reduced right ventricular systolic function, right-sided chamber dilation, or elevated RVSP—were present in 74% (28/38). Despite these findings, only 18% (7/38) had a charted PH diagnosis and none received PH-specific therapy. Additionally, 92% (35/38) had preserved left ventricular ejection fraction (≥50%), suggesting normal left-sided function. From a pulmonary perspective, 45% (17/38) had documented fibrotic lung disease (IPF, PPF, ILD, or pulmonary fibrosis), yet only 18% (3/17) received antifibrotic treatment. Conclusion In this cohort of patients with CT evidence of pulmonary honeycombing, 74% demonstrated echocardiographic signs of potential PH, yet only 18% had a PH diagnosis and none were treated with PH-specific therapy. Additionally, although 45% had documented fibrotic lung disease, only 18% received antifibrotic treatment. These findings highlight a persistent gap in the recognition and management of group 3 PH and fibrotic lung disease, even among patients evaluated by pulmonologists. Strengthening collaboration between pulmonology and cardiology is essential to ensure timely diagnosis and appropriate therapy. This abstract is funded by: None
Guet-Cruza et al. (Fri,) studied this question.
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