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2. Bronchopneumonia
The focal right lower lobe consolidation and mild volume loss are consistent with, although not specific for, bronchopneumonia. Bronchogenic malignancy is a consideration because occasionally this neoplasm may present with focal lobar consolidation, or the primary malignancy may obstruct a bronchus and produce post-obstructive consolidation. However, bronchogenic malignancy would be extremely uncommon in an 18-year-old patient (note, however, other pulmonary malignancies, particularly carcinoid tumor, may present in young patients). Pulmonary alveolar proteinosis typically presents as a bilateral process, manifesting as diffuse lung disease, not an area of focal consolidation. Langerhans cell histiocytosis commonly presents as an upper lobe predominant cystic / cavitary and nodular process, not as lower lobe focal consolidation. Eosinophilic granulomatosis with polyangiitis (formerly referred to as Churg-Strauss syndrome), has a number of non-specific presentations, commonly manifesting as areas of multifocal opacity, often peripheral in distribution, representing areas of pulmonary hemorrhage. Focal opacities that may cavitate are also possible, but the process is typically not focal or lobar in distribution.
Which of the following represents the most appropriate next step for the management of this patient? (Click on the correct answer to proceed to the fourth of eight pages)