Correct!
3. Thoracic CT scan
The patient may well have pneumonia but the presentation with chronic nonproductive cough alone, lack of fever, and a LUL nodule is somewhat unusual. Since the patient was immunocompromised from her CLL, an infection other than community-acquired pneumonia is quite possible. Therefore, empiric antibiotics for community-acquired pneumonia alone are a poor choice unless begun while awaiting further diagnostic studies. Needle biopsy is probably premature, does not sample the airways and exposes the patient to a potential bleeding risk. Thoracic CT is indicated to better define the pulmonary nodule and because other abnormalities might be found (Figure 3).
Figure 3. Representative images from the thoracic CT scan in lung windows (A-E) and soft tissue windows (F).
Which of the following should be done next? (Click on the correct answer to proceed to the fourth of five pages)