Correct!

5. All of the above

The differential diagnosis of shortness of breath in this situation is large and includes pneumonia from typical bacteria such as Streptococcus pneumoniae, atypical pneumonia in an immunocompromised host; complications of drugs and/or radiation; progression of underlying lung cancer; or a variety of other causes not related to her underlying disease. A repeat thoracic CT scan was performed and compared to a previous CT scan from October 2012 (Figure 2).

Figure 2. Selected views from thoracic CT scans done 10/5/13 (A-E) and corresponding views from 1/3/13 (F-J).

Which of the following should be done next? (click on correct answer to move to next panel)

  1. 18FDG-PET scanning
  2. Bronchoscopy with transbronchial biopsy
  3. Open surgical lung biopsy
  4. Percutaneous transthoracic needle biopsy
  5. Serial imaging to assess for change

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