Interstitial lung diseases (ILD) is a heterogeneous group of over 200 different diseases of unknown and known cause with common functional characteristics (restrictive physiology and impaired gas exchange) and a common fnal pathway, eventually leading to irreversible fbrosis . In this chapter, the radiographic imaging of the more common conditions of ILD is reviewed, and in particular, Idiopathic Interstitial Pneumonias (IIP), in relation to the presence of pulmonary hypertension, is discussed. A special emphasis is placed on the role of high-resolution computed tomography (HRCT) fndings in association with Pulmonary Hypertension (PH) . In 2002, the ATS/ERS multidisciplinary panel proposed a classifcation of IIP that comprises clinical– pathological entities such as Idiopathic Pulmonary Fibrosis. (IPF), Nonspecifc Interstitial Pneumonia (NSIP), Respiratory Bronchiolitisassociated Interstitial Lung Disease (RB-ILD), Cryptogenic Organizing Pneumonia (COP), Acute Interstitial Pneumonia (AIP), Desquamative Interstitial Pneumonia .(DIP), and lymphoid interstitial pneumonia (LIP) IPF is the most common subset IIP occurring most frequently in patients older than 50 years of age, limited to the lower lungs, and associated with a histological pattern termed usual interstitial pneumonia (UIP). Symptoms include dry cough, progressive dyspnea, and fnger clubbing that usually precede presentation by 6 months [10–18]. Physiological examination shows crackles over the lower lungs specifc for IPF with a high level of accuracy near 100%. In our opinion, only two approaches would allow an earlier diagnosis of IPF: (a) assessment of Velcro crackles by lung auscultation and (b) screening using HRCT.