Correct!
2. Abnormal thickening of the anterolateral trachea is present.
This thickening is diffuse- it involves the entire visualized trachea, and shows spotty, multifocal calcification (Figures 5 and 6).
Figure 5. Inspiratory thoracic CT axial images showing diffuse thickening with calcification involving the anterior two-thirds of the trachea, mainstem bronchi, and lobar bronchi in a symmetric fashion bilaterally (arrows).
Figure 6. Expiratory thoracic CT axial images showing tracheobronchial thickening, calcification, and malacia (arrows) particularly evident at the mainstem bronchial level (Figure 6D).
No mediastinal mass or pleura disease is present, and there are no abnormal gas collections or chest wall masses. Mild internal mammary lymph node enlargement is present and borderline right paratracheal and subcarinal lymph nodes are seen, although no frank mediastinal lymphadenopathy is noted.
Initially the patient’s cough and joint aches improved somewhat when his corticosteroid dose was increased from 40 mg/day to 60 mg/day. However, he later developed ear and nose pain as well as a deformity of the morphology of the nose. He also complained of worsening joint pain. Hyperglycemia was noted now as well.
What is the appropriate next step for the evaluation / management of this patient?