Correct!
1. Bronchoscopy with bronchoalveolar lavage
The imaging presented clearly shows a progressive lung abnormality rather than pulmonary opacities secondary to a vascular process, such as pulmonary embolism or causes of pulmonary hypertension. While sampling of the pleural fluid is not an absolutely incorrect answer, the effusions are rather small and difficult to sample in this patient, and are unlikely to harbor management-altering information. The symmetry of the process and diffuse nature of the abnormality, as well as the lack of known predisposing factors, make aspiration very unlikely as the cause of the patient’s lung disease, and such studies cannot be performed in obtunded and intubation patients regardless.
The patient subsequently underwent bronchoscopy with bronchoalveolar lavage, which showed acute inflammation, no evidence of infection, and abundant eosinophils (bronchoalveolar lavage differential cell count = 40% eosinophils).
Corticosteroids were begun. The patient’s respiratory status began to improve rapidly (Figure 6).
Figure 6: Frontal chest radiograph following the administration of corticosteroids shows marked clearing of bilateral pulmonary opacities.
The patient was subsequently extubated and discharged from the hospital 11 days after admission.
Which of the following is the most likely diagnosis for this patient?