Correct!
5. Unenhanced thoracic CT

While thoracic CT would be appropriate for the evaluation of this patient, given the presence of a significant obstructive abnormality at pulmonary function testing, it is important to include post-expiratory imaging to assess for air trapping as part of the CT protocol. Routine thoracic CT does not include post-expiratory imaging, but high-resolution chest CT (HRCT) does, so high-resolution chest CT is the best choice among those listed. 68Ga-citrate imaging can be used for diffuse lung diseases, but typically in the context of alveolitis, not obstructive lung disease. Flexible fiberoptic bronchoscopy and right heart catheterization could be of benefit for this patient, but are invasive and HRCT results could inform which of these invasive procedures may be indicated..

The patient underwent unenhanced HRCT (Figures 2 and 3).

Figure 2 (left). Video of axial inspiratory HRCT displayed in lung windows. Figure 3 (right). Video of axial expiratory HRCT displayed in lung windows.

Which of the following is correct regarding the description of the thoracic CT findings? (Click on the correct answer to proceed to the fifth of seven panels)

1. HRCT shows multifocal bilateral areas of lobular low attenuation on inspiratory imaging and air trapping on post-expiratory imaging
2. HRCT shows multifocal bronchiectasis
3. HRCT shows multifocal ground-glass opacity
4. HRCT shows numerous small nodules consistent with a miliary pattern
5. HRCT shows patchy areas of peribronchial consolidation

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