Correct!
1. Bronchoscopy with bronchoalveolar lavage
Correct!
1. Bronchoscopy with bronchoalveolar lavage
The patient is immuncompromised because of his diabetes, his ketoacidosis and his previous history of Candida esophagitis and at high risk for an atypical pulmonary infection (2). His chest x-ray has clearly worsened and peripheral infiltrates are noted on the thoracic CT scan. Sputum Gram stain is often unreliable in this setting and it will be several days before cultures are returned. Although the patient might have fungal pneumonia, most would establish the diagnosis before beginning empiric antifungal therapy. VATS seems overly invasive and transtracheal needle aspiration has largely been replaced by bronchoscopy with bronchoalveolar lavage.
Bronchoscopy was performed and there were no endobronchial lesions observed. Gram, silver and acid fast stains were all negative. The differential from his bronchoalveolar lavage is shown in table 1.
Table 1. Bronchoalveolar lavage (BAL) differential.
Which of the following should be done next? (Click on the correct answer to proceed to the fourth and final panel)
