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1. Bronchoscopy with endobronchial ultrasound (EBUS)
The presence of the new lung lesion is worrisome and suggests progression of her disease. It seems unlikely that a PET/CT scan would be useful since most of the diagnostic possibilities would likely result in increased uptake in the lung and the hilar mass. Regardless, it seems that a tissue diagnosis is warranted and either bronchoscopy, needle biopsy or VATS seem reasonable. Her physicians in Iowa chose to proceed with bronchoscopy with EBUS. The biopsy from the enlarged left hilar lymph nodes showed lymphocytes and inflammation but no malignancy. Special stains and cultures were negative. They felt the diagnosis was unclear but most likely sarcoidosis.
She returned to Phoenix in June. Her symptoms were unchanged. Another thoracic CT was very similar to the one done in Iowa.
Which of the following is indicated at this time? (Click on the correct answer to proceed to the fifth of seven pages)