Correct!
3. The thoracic CT shows multifocal ground-glass opacities
The thoracic CT shows multifocal areas of ground-glass opacity bilaterally, but without features to suggest fibrotic lung disease (such as traction bronchiectasis, architectural distortion, reticulation, and / or honeycombing). Additionally, there is no evidence of “crazy paving”, typically defined as “thickened interlobular septa and intralobular lines superimposed on a background of ground-glass opacity, resembling irregularly shaped paving stones. The crazy-paving pattern is often sharply demarcated from more normal lung and may have a geographic outline.” The differential diagnosis for the “crazy paving” pattern includes a fairly broad spectrum of disorders, but the pattern is often seen in patients with pulmonary alveolar proteinosis. While there is multifocal ground-glass opacity on this patient’s CT, there is no interlobular septal thickening associated with the ground-glass opacity, and therefore the “crazy paving” pattern is not present. The areas of increased attenuation on the CT are best described as “hazy increased opacity of lung, with preservation of bronchial and vascular margins”; in other words, ground-glass opacity. The terms ground-glass opacity contrasts with consolidation, typically defined as “homogeneous increase in pulmonary parenchymal attenuation that obscures the margins of vessels and airway walls,” often with air bronchograms; this imaging pattern is not present on the CT images in Figure 1.
The patient underwent echocardiography which showed an ejection fraction of 55% with severe bi-atrial enlargement and left ventricular hypertrophy, and increased echogenicity affecting the left ventricular muscle, suggesting the possibility of cardiomyopathy.
Which of the following represents an appropriate consideration for the condition affecting this patient? (Click on the correct answer to proceed to the fourth of five panels)