Abstract Introduction In patients with honeycombing noted on imaging, dyspnea is often multifactorial, and these individuals are frequently evaluated by cardiologists before pulmonologists. This typically includes cardiac testing such as echocardiography. One important contributor that is often missed or delayed is pulmonary hypertension (PH). Although PH is formally diagnosed by right heart catheterization, thoracic imaging findings and right-sided heart changes on echocardiogram should raise suspicion for group 3 PH. With expanding treatment options for fibrotic lung disease and PH-ILD, timely identification of patients at risk for group 3 PH is essential for evaluation and potential therapy. 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 charts with honeycombing on CT imaging, 49 patients were not evaluated by a pulmonologist despite findings of honeycombing. Of these, 65% (32/49) had been seen by a cardiologist, and 30 underwent echocardiography. Indirect signs of PH—such as reduced right ventricular systolic function, right-sided chamber dilation, or elevated RVSP—were present in 73% (22/30). Despite these findings, only 22% (7/32) had a charted PH diagnosis, and none underwent right heart catheterization or received PH-specific therapy. Additionally, 87% (26/30) had preserved left ventricular ejection fraction(≥50%), suggesting normal left-sided function. From a pulmonary perspective, 41% (13/32) had documented fibrotic lung disease (IPF, PPF, ILD, or pulmonary fibrosis), yet only 23% (3/13) received antifibrotic treatment. Conclusions In this cohort with imaging suggestive of ILD, 73% demonstrated echocardiographic signs of possible PH, yet only 22% had a PH diagnosis and none were treated for PH. A key limitation may be that only 41% had a formal fibrotic lung disease diagnosis despite honeycombing on imaging. These findings highlight a critical gap: patients who should be evaluated for group 3 PH are often overlooked, and even those identified are not receiving appropriate therapy. Both pulmonologists and cardiologists should recognize indirect signs of PH in patients with honeycombing to ensure timely diagnosis and treatment. This abstract is funded by: None
Clayton et al. (Fri,) studied this question.
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