Bronchiectasis is irreversible dilation of the bronchi resulting from airway damage due to a variety of causes, including infection, airway obstruction, or fibrosis.7 By definition, traction bronchiectasis results from fibrotic tissue “pulling” on the bronchi, while freestanding bronchiectasis is unrelated to fibrosis.7 Traction bronchiectasis is often seen at the periphery of the lung where there is less supportive connective tissue, leaving the bronchi prone to distortion.10 Peripheral, lower-lobe predominant traction bronchiectasis in the setting of changes consistent with fibrosis is highly suggestive of IPF.5,45