Correct!
2. Bronchoscopy with bronchoalveolar lavage
A PET scan is usually for assessing the metabolic activity of a pulmonary nodule and a CT angiogram is usually to evaluate for abnormal pulmonary vasculature. There is no evidence of a nodule or pulmonary vascular abnormality. Several potential diagnoses may be identified with bronchoscopy with bronchoalveolar lavage, potentially saving the patient an open lung biopsy.
The bronchoscopy with bronchoalveolar lavage had a negative cytology and smears. A cell differential was requested on the fluid, but was not performed due to a laboratory problem with specimen processing.
She was empirically begun on fluconazole. However, the patient continued to deteriorate and was transferred to the ICU. A trial of BiPAP failed and she was intubated on day 5 of hospitalization due to worsening hypoxia and respiratory distress. A video-assisted thorascopic (VATS) lung biopsy was performed (Figure 4).
Figure 4. Representative images from the VATS lung biopsy (Panels A-C) including a high power image of Panel B (Panel D).
Which of the following should be done next?