Distinguishing between honeycombing and paraseptal emphysema may be difficult, especially when coexisting on a single scan. As compared with honeycombing, which may present as multiple layers of cysts stacked upon one another, emphysema presents as a single layer of holes without stacking.7 Furthermore, emphysematous holes are typically not hexagonal; therefore, the shape of the cysts and their propensity to stack can help to distinguish one from the other.7

guildline mic

Idiopathic Pulmonary Fibrosis (an Update) and Progressive Pulmonary Fibrosis in Adults: An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline

Reference

7. Hansell DM, Bankier AA, MacMahon H, et al. Fleischner Society: glossary of terms for thoracic imaging. Radiology. 2008;246:697-722.