Correct!
2. Lipoid pneumonia
The least likely etiology for the observed radiographic findings among those listed is lipoid pneumonia. Lipoid pneumonia can certainly present as a focal opacity, even mass-like; this manifestation has sometimes been referred to as “paraffinoma”. Typically, however, lipoid pneumonia may show areas of low attenuation, representing fat, and, more importantly in this case, lipoid pneumonia typically does not calcify. Sarcoidosis can present in a fashion similar to what is seen in this patient, causing upper lobe predominant masses resembling “progressive massive fibrosis.” Furthermore, sarcoidosis often causes calcification. Fungal infections could rarely present in this fashion as well. Although uncommon, metastatic lesions in the thorax could cause large masses that calcify- this is particularly true of osteosarcoma and chondrosarcoma (technically ossification in the former case). Occupational lung diseases and environmental exposures, particularly complicated chronic silicosis, can present with upper lobe masses with calcification.
Which of the following would be most useful for further evaluation of this patient? (Click on the correct answer to proceed to the sixth of seven pages)