Correct!
3. Chest CT scan
A CT scan will better define the nodules and help narrow the differential diagnosis. VATS and brain biopsy seem overly aggressive at this point. A low CD4+ T lymphocyte count is often seen with HIV+ infection but there is no evidence that the patient has AIDS. Serum prolactin levels are elevated after a generalized tonic-clonic seizure and may be useful in distinguishing between a seizure and a nonepilform event. However, the prolactin decreases after the seizure fairly quickly.
The thoracic CT scan is shown in Figure 2.
Figure 2. Representative images from the thoracic CT scan. Panels A-D: lung windows. Panels E and F: soft tissue windows.
What is the most likely cause of the small lesions on the thoracic CT scan and the lesion in brain? (Click on the correct answer to procced to the sixth of seven panels)