Correct!
2. Bronchoscopy with transbronchial biopsy

None of the choices other than following the thoracic CT are wrong. However, in my view the best choice in this situation is bronchoscopy with transbronchial biopsy. Although it has lower yield than needle biopsy or VATS, it has a lower complication rate and has the added advantage of visualizing the airways (2). Bronchoscopy with transbronchial biopsies was performed (Figure 3).

Figure 3. H&E staining of the low (Panel A), intermediate (Panel B) and high power (Panel C) of the transbronchial lung biopsies.

What is the likely diagnosis?

  1. Granulomatosis with polyangitis (GPA)
  2. Metastatic breast cancer
  3. Sarcoidosis
  4. Tuberculosis
  5. Valley fever

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