Correct!
1. Check titers for possible fungal infection, treat presumptively with broad-spectrum antibiotics for presumed pneumonia
Among the choices listed, treating with broad-spectrum antibiotics for presumed pneumonia, and checking for titers suggesting fungal infection, particularly coccidioidomycosis (given that this infection is responsible for a significant proportion of community-acquired pneumonias) is appropriate. The chest radiographic findings, while not specific for pneumonia alone, are certainly consistent with that diagnosis. The lack of fever and the normal white blood cell count are unusual findings for pulmonary infection, but that diagnosis remains a consideration, and, “common things being common,” the diagnosis of community-acquired pneumonia remains a strong possibility. The patient has no pleural effusion and therefore pleuroscopy is not an appropriate choice. Surgical lung biopsy is needlessly invasive at this point. 18FDG-PET probably would not provide management-altering results- active tracer utilization within the area of left lower lobe consolidation would be expected in the setting of pneumonia. The lack of tracer utilization within the left lower lobe abnormality would be a peculiar result that would be difficult to interpret. Most infections would be expected to result in tracer utilization, but the lack of an intense inflammatory response could result in false negative findings at 18FDG-PET.
The patient’ was treated with broad-spectrum antibiotics for several weeks and the patient’s cough improved somewhat. The patient remained afebrile. Testing for various infectious agents was pending. Frontal and lateral chest radiography (Figure 3) was repeated.
Figure 3. Repeat frontal (A) and lateral (B) chest radiography. Chest radiograph from 2 weeks earlier (C and D) is shown for comparison.
Which of the following represents the most accurate assessment of the repeat chest radiographic findings? (Click on the correct answer to proceed to the fourth of eleven pages)