Correct!
1. Chronic eosinophilic pneumonia
Among the entities listed, chronic eosinophilic pneumonia is the least likely diagnosis as recent bronchoscopy failed to show significant pulmonary eosinophilia, which is practically always present in this disorder. Three of the entities listed- granulomatosis with polyangiitis, microscopic polyangiitis, and eosinophilic granulomatosis with polyangiitis- are vasculitides that may present with pulmonary hemorrhage, and are all appropriate considerations for the etiology of the lung disease in this patient, given the CT appearance and history of hemoptysis and blood demonstrated at bronchoalveolar lavage. Follicular bronchiolitis can present with areas of ground-glass opacity, including foci of centrilobular ground-glass nodules, at thoracic CT, and may occur in the context of connective tissue disorders; the latter is a consideration given the weakly positive anti-nuclear antibody test.
The patient returned for evaluation 3 months after presentation. He indicated he had not suffered any episodes of hemoptysis, and that he was doing well, exercising regularly. Review of systems revealed no complaints of shortness of breath, night sweats, or dyspnea on exertion. He did admit to a morning cough, which he attributed to night time reflux.
Repeat unenhanced thoracic CT (Figure 3) was performed.
Figure 3. A-F: Representative images from the axial thoracic CT, performed 3 months after initial presentation, displayed in lung windows. Right: video of axial CT in lung windows.
Which of the following statements regarding this imaging study is most accurate? (Click on the correct answer to proceed to the sixth of nine pages)