3. Numerous bronchial-associated ground glass opacities

The thoracic CT scan is clearly abnormal with numerous rounded densities most of which have a bronchus in the center. The bronchi are well preserved and this would favor an acute pneumonitis over metastatic carcinoma although this is not diagnostic. A mosaic pattern is produced with interlobular and intralobular septal thickening (see July 2015 Pulmonary Case of the Month: A Crazy Case for an example). The halo sign  occurs when a solid nodule is surrounded by a ground-glass opacity (see September 2015 Imaging Case of the Month for an example).

What is the best next step in evaluating the patient? (Click on the correct answer to proceed to the third of four pages)

  1. Bronchoscopy with bronchoalveolar lavage and transbronchial biopsy
  2. Empiric antibiotics with careful observation
  3. Repeat the thoracic CT scan
  4. Thoracic CT angiogram
  5. Video-assisted thorascopic biopsy (VATS)