Correct!
Answer: 2. Symmetrically small kidneys bilaterally, consistent with renal failure, are present.

The visualized liver contour appears normal and the small bowel shows normal caliber- neither cirrhosis nor small bowel obstruction is seen. The spleen is not visible on the images shown. The images show small, atrophic kidneys consistent with chronic renal failure and renal atrophy.)

Figure 5: Axial unenhanced abdominal CT shows small atrophic kidneys bilaterally, consistent with chronic renal failure (arrows). The visualized liver, colon, and small bowel appear normal.

After review of the abdominal CT images, it was learned that the patient had chronic renal failure and had undergone previous hemodialysis and renal transplantation; the latter was also failing. Based on all the foregoing information, which of the following is the most likely etiology for apical abnormalities on the chest radiograph?

1. Active opportunistic infection in an immunosuppressed patient following renal transplantation
2. The development of pulmonary post-transplant lymphoproliferative disorder
3. Metastatic pulmonary calcification
4. Volume overload and hydrostatic pulmonary edema in a patient with renal failure
5. The findings are suggestive of subacute hypersensitivity pneumonitis

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