1. A pulmonary nodule is present in the left upper lobe (LUL)

The chest x-ray shows a 3 cm LUL nodule (Figure 2).

Figure 2. Chest x-ray showing 3 cm LUL nodule (circled).

Pneumonia is the most frequent pulmonary complication of CLL (1). Patients with pneumonia may occasionally be afebrile. To my knowledge, ibrutinib has not been associated with cough.

Which of the following should be done at this time? (Click on the correct answer to proceed to the third of five pages)

  1. Begin empiric antibiotics for presumptive community-acquired pneumonia
  2. Needle biopsy the LUL nodule
  3. Thoracic CT scan
  4. 1 and 3
  5. All of the above