Correct!
1. Bronchoscopy with transbronchial biopsy
Pulmonary function testing revealed a mild-moderate reduction in forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), total lung capacity (TLC) and diffusing limit for carbon monoxide (DLco). An ultrasound of the heart specifically looking for evidence of pulmonary hypertension was normal. Thoracic CT scan is shown in Figure 3.
Figure 3. Selected thoracic CT scan in lung windows (panels A-D) and soft tissue windows (Panel E-H). Lower left: video of thoracic CT in lung windows. Lower right: video of thoracic CT in soft tissue windows.
The CT scan confirms the presence of the reticulonodular infiltrates and also identifies scattered small cysts.
Bronchoscopy with transbronchial biopsy would be reasonable except on further questioning the patient admits to an open lung biopsy about 15 years earlier when she presented with a pneumothorax. The original slides are no longer available but the pathology report was obtained.
Which of the following would you expect on the pathology report? (Click on the correct answer to proceed to the fourth of five panels)