Correct!
1. Broncholitis obliterans
Correct!
1. Broncholitis obliterans
Congenital lobar overinflation / emphysema is rare in adults, and often represents as a lobar area of low attenuation, possibly with airway thickening and dilation, rather than multifocal bilateral areas of lobular low attenuation and air trapping. Furthermore, one of the oldest reported patients with congenital lobar overinflation / emphysema was aged 37 at diagnosis- substantially younger than this patient. Congenital cystic pulmonary airway malformation typically presents as a focal low attenuation areas with variably-sized thin-walled cysts, rather than the multifocal bilateral areas of lobular low attenuation and air trapping seen at thoracic CT in this patient. Emphysema may present as upper lobe areas of circumscribed low attenuation without walls (centrilobular emphysema), more confluent and often lower lobe areas of lobular low attenuation, with stretched and attenuated pulmonary vessels, creating the appearance of lung parenchymal “simplification” (panlobular emphysema), and/or discrete areas of upper lobe predominant subpleural thin-walled cysts or bullae (paraseptal emphysema)- all of these appearances are distinct from the CT pattern present in this patient. Finally, this patient is a life-long non-smoker.
At this point, which of the following tests would be most useful for establishing the diagnosis for this patient? (Click on the correct answer to proceed to the seventh and final panel)