Correct!
5. Thoracic CT scan

In immunocompromised hosts a conservative approach can be risky. The patient may progress quickly. Therefore, following the patient with serial chest x-rays is not appropriate. Needle biopsies are usually done for masses although it could be done in this case. PET scans are usually done to assess the metabolic activity of masses. It is unclear how that would be helpful in this case. CT angiography is usually done for pulmonary embolism, which although possible, is unlikely. Therefore a thoracic CT scan was performed (Figure 3).

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Figure 3. Panels A-D: Representative static lung windows from the thoracic CT scan. Lower panel: movie of CT scan lung windows.

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

  1. Bronchoscopy with bronchoalveolar lavage and transbronchial biopsy
  2. Video-assisted thoracoscopy (VATS)
  3. Pulmonary function testing
  4. 1 and 3
  5. All of the above

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