Correct!
5. The thoracic CT shows right lower lobe bronchiectasis
The unenhanced and enhanced thoracic CT shows patchy areas of ground-glass opacity and reticulation, likely inflammatory and potentially infectious in nature. These opacities are far too inconspicuous to be visible at chest radiography. Right lower lobe bronchiectasis is present and accounts for the findings seen at chest radiography (arrows). Right lower lobe bronchial impaction is seen at the cranial / central aspect of the right lower lobe bronchiectasis (curved arrow, Panel O). Mediastinal lymph nodes measuring near the upper limits of normal for size are present, but no frank mediastinal lymph node enlargement is seen, although right peribronchial lymph nodes are mildly enlarged. Enlarged mediastinal bronchial arteries extending into the peribronchial region are seen. The unenhanced thoracic CT shows that a focus of high attenuation focus is located at the cranial / central aspect of the right lower lobe bronchiectasis, in the right basal bronchial trunk, just distal to the origin of the medial basal segmental right lower lobe bronchus. No pulmonary emboli are present and there is no evidence of pulmonary arterial aneurysms. The pulmonary arteries are normal in size, which argues against the presence of pulmonary hypertension. No prior imaging was available for the patient.
In addition, closer inspection of the CT scan shows the presence of a bronchial opacity (Figure 3).
Figure 3. Axial unenhanced thoracic CT displayed in soft tissue windows shows at the cranial / central aspect of the right lower lobe bronchiectasis, a high attenuation focus (A, block white arrow) is present. Also visualized is focal basal segmental and subsegmental bronchial impaction (B & C, curved arrows) in the area of bronchiectasis.
Which of the following represents the most appropriate next step for the managementof this patient? (Click on the correct answer to proceed to the sixth of eight pages)