Interstitial lung diseases (lLD) are a large group of rare diseases, with difficult diagnosis and management. Very little is known about prevalence, diagnosis and management of ILDs in Romania. This study aims to gather information on how ILDs are diagnosed and managed in Romania, focusing on a tertiary hospital with expertise and equipment needed for accurate diagnosis. We analyzed retrospectively the files of patients admitted with ILD in 2011 in "Marius Nasta" Institute of Pulmonology Bucharest. There were 178 eligible patient files with ILDs and 186 sarcoidosis cases. The ILD diagnosis were: 41 cases idiopathic pulmonary fibrosis (IPF), collagen disease associated ILD (29 cases), hypersensitivity pneumonia (19 cases), alveolar proteinosis (9 cases), cryptogenic organizing pneumonia (9 cases), undefined ILD (46 cases), other (25 cases). The investigations used for the diagnosis were: chest X-ray (100%), spirometry (157pts, 88.21%), diffusion capacity (127 pts, 71.43%, broncho-alveolar lavage (92 pts, 51.69%), CT scan (141 pts, 79.22%), lung biopsy (26 pts, 14.6%), similar to other European centers, but fewer lung biopsies are performed. There is need for a prospective registration of ILD cases in a national registry, for creating local guidelines for diagnosis of ILDs, to improve the suspicion of ILD and referring of patients to specialized centers. Diagnosis can be improved by a multidisciplinary approach of each case, involving the clinician, the radiologist, the pathologist and the thoracic surgeon.