Correct!
5. Video-assisted thorascopic biopsy (VATS)

The next step which will likely result in a diagnosis is video-assisted thorascopic biopsy (VATS). The nodules most likely are random nodules. CT/PET scan could be performed but whether it is positive or negative a biopsy needs to performed. Mediastinoscopy is usually performed for enlarged mediastinal lymph nodes but there are no abnormal appearing nodes on the CT scan. Needle biopsy is usually performed for a pulmonary masses (> 2 cm). Serum angiotensin converting enzyme (ACE) is often elevated in sarcoidosis which seems unlikely from the clinical presentation.

The biopsy showed nodules consisting of diffuse infiltration of mature lymphocytes, plasma cells and histiocytes. There were no malignant cells apparent (Figure 4).

Figure 4. H & E stained lung biopsy showing nodule with a diffuse infiltration of mature lymphocytes, plasma cells and histiocytes. Normal lung is shown in the upper right.

A diagnosis of lymphocytic interstitial pneumonia (LIP) was made (1,2).

Which of the following diagnosis has been associated with LIP? (Click on the correct answer to proceed to the tourth of five panels)

1. Acquired immunodeficiency syndrome (AIDS)
2. Hypogammaglobulinemia
3. Sjogren's syndrome
4. Systemic lupus erythematosus (SLE)
5. All of the above

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