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. 2020 Aug 1;202(3):e36–e69. doi: 10.1164/rccm.202005-2032ST

Figure 7.

Figure 7.

Algorithm for the diagnostic evaluation of possible hypersensitivity pneumonitis (HP). Specific features are described for all steps of the algorithm in the corresponding sections of the manuscript. A provisional diagnosis may be adequate in patients for whom the differential diagnosis has been sufficiently narrowed such that further investigations are unlikely to alter management, when invasive testing has unacceptable risks, or when such tests are declined by the patient. *Exposure assessment includes a thorough clinical history and/or serum IgG testing against potential antigens associated with HP and/or, in centers with the appropriate expertise and experience, specific inhalational challenge testing as described in References 9, 323, 324, and 325. **High-resolution computed tomography should be performed using the technique described in Table 3 and then reviewed with a thoracic radiologist. ***Transbronchial lung biopsy is suggested for patients with potential nonfibrotic HP (see question 4, recommendation 1). #TBLC is suggested for patients with potential nonfibrotic HP, depending on local expertise (see question 5, recommendation 2). ##SLB is infrequently considered in patients with nonfibrotic HP. HRCT = high-resolution computed tomography; SLB = surgical lung biopsy; TBLB = transbronchial lung biopsy; TBLC = transbronchial lung cryobiopsy.