Correct!
3. Surgical lung biopsy
The patient underwent bronchoscopy with transbronchial biopsy and that procedure was uneventful and without complication; repeating the exam is unlikely to provide new actionable information, particularly as no clear lymphadenopathy is present. As noted previously, 18FDG-PET scanning is typically employed for staging malignancies and evaluating solitary pulmonary nodules, and not for the investigation of interstitial abnormalities. The absence of tracer utilization within the lung parenchymal abnormalities at 18FDG-PET scanning in this patient would not obviate the need for a tissue diagnosis, whereas the presence of tracer uptake within the pulmonary abnormalities would merely reaffirm the need for such; therefore, 18FDG-PET scanning is unlikely to provide management-altering information for this patient. Repeating the HRCT, or performing a repeat thoracic CT using pulmonary angiographic technique, would also probably not provide useful information in a patient with multifocal interstitial abnormalities and significant respiratory symptoms; indeed, the lung parenchymal findings are unlikely to be the result of thromboembolic disease. At this point, surgical lung biopsy is an indicated procedure.
The patient underwent repeat chest CT (Figure 5).
Figure 5. Upper Panels A-I: Axial enhanced thoracic CT displayed in lung windows performed 1 month after the presentation thoracic CT (Figure 3). Lower panel: video of axial enhanced thoracic CT scan in lung windows.
Which of the following represents the most accurate assessmentof the repeat high-resolution chest CT findings? (Click on the correct answer to proceed to the tenth and final page)