Correct!
2. Review the previous open lung biopsy
Although bronchoscopy with bronchoalveolar lavage is not wrong, it is unclear what would be gained at this point. Repeating the open lung biopsy is again overly aggressive. PET scanning is usually indicated for evaluation of the metabolic activity of lung nodules.
Multiple lung pathologies are associated with rheumatoid arthritis, however, the evidence for rheumatoid arthritis in this patient is weak. Therefore, increasing the prednisone is not indicated. Review of the previous open lung biopsy seems the most reasonable approach.
The previous open lung biopsy was interpreted as showing nodular foci of fibrinous and organizing pneumonitis accompanying chronic small airways disease. There are also areas of granulation tissue within the respiratory bronchioles (Figure 2).
Figure 2. Low power view (Panel A) with higher power views (Panel B and C).
Which of the following most likely explains the patient’s lung pathology?