Correct!
6. All of the above
All of the possibilities listed may produce multiple pulmonary nodules and cavities. Distinguishing among these possibilities requires clinical information (i.e., if the patient has a known primary malignancy, usually a squamous cell malignancy), or whether or not the patient has a clinical presentation suggestive of septic embolization (such as fever, a history of an infected indwelling catheter, endocarditis, intravenous drug abuse, etc). Cavity pulmonary amyloidosis is extremely uncommon, and may or may not be accompanied by other systemic features of amyloidosis, but can be diagnosed with biopsy of affected tissue. Similarly, cavitary rheumatoid nodules are rare, and features of rheumatoid arthritis may, or may not, be evident simultaneously. Granulomatosis with polyangiitis (aka Wegener’s Granulomatosis) may be associated with features of renal involvement and / or sinus disease, and elevated c-anti-neutrophil antibodies against protease 3 in cytoplasmic granules (c-ANCA), and sometimes myeloperoxidase, may be present in 90% or more of affected patients.
Further investigation found that the patient had red cell casts in his urine, but no evidence of sinonasal disease.
What is the appropriate next step for the evaluation/management of this patient?