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5. Radiation pneumonitis
The thoracic CT scan shows dense consolidation near the radiation port consistent with radiation pneumonitis. Although changes in the lung are usually confined to the port, changes in the remainder of the lung may also on occasion be seen. Complaints with radiation pneumonitis usually include cough and dyspnea sometimes with low grade fever, chest discomfort or pleuritic pain. She underwent bronchoscopy with transbronchial biopsies which was reported to show only “organizing pneumonitis.” Cultures were negative. She was felt to most likely have radiation pneumonitis. She was treated with oral corticosteroids for one month with resolution of her symptoms and the corticosteroids were tapered.
However, her symptoms recurred about a month after tapering the steroids and she was referred to the Mayo Clinic for evaluation. At that time her oxygen saturation was 96% with a few crackles on the right lung field noted. Laboratory evaluation was unremarkable except for an elevated C-reactive protein.
A repeat thoracic CT scan was obtained (Figure 3).
Figure 3. Representative images from the repeat thoracic CT scan in lung windows.
Which of the following should be done next? (Click on the correct answer to move to the fourth and final panel)