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1. The thoracic CT shows a diffuse infiltrative abnormality involving both the pulmonary parenchyma and mediastinal soft tissues
The thoracic CT shows a diffusely infiltrating abnormality involving the pulmonary parenchyma and mediastinal soft tissues (Figure 3, Panels A-D, arrows).
Figure 3. Thoracic CT shown in lung windows (Panels A-D) shows a diffuse linear pattern representing smooth interlobular septal thickening (arrows). The CT images shown soft tissue windows (Panels E-H) shows extensive soft tissue infiltration around the aorta, pulmonary artery, and the heart and pericardium (arrows).
Within the lung parenchyma, the infiltrative process primarily manifests as smooth interlobular septal thickening without features of fibrosis, such as architectural distortion. The pulmonary parenchymal abnormality is a linear pattern, not a small nodular pattern, nor one of multifocal nodular consolidation. The mediastinal soft tissue infiltration is seen in a perivascular location, surrounding the aorta and main pulmonary artery, as well as around the heart and pericardium (Figure 3, Panels E-H, arrows). This abnormal soft tissue does not entirely conform to the typical position of hilar and mediastinal lymph nodes.
Further exploration of the patient’s history disclosed complaints of bilateral lower leg pain and eye pain. Extremity radiographs (Figure 4), nuclear medicine Tc-99m methylene diphosphonate (MDP) bone scanning (Figure 5), and MRI of the brain (Figure 6) were subsequently performed to investigate these complaints.
Figure 4. Radiography of the tibia and fibula.
Figure 5. Tc-99m methylene diphosphonate bone scan.
Figure 6. Unenhanced (A) and enhanced (B) T1-weighted MRI images of the brain
What is the appropriate next step for the evaluation / management of this patient?