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3. Thoracic CT shows multifocal peripheral nodular opacities
The thoracic CT shows multifocal, bilateral areas of peripheral, and frankly subpleural, opacities. The opacities are nodular in some regions, but unassociated with features of fibrotic lung disease, such as traction bronchiectasis, coarse reticulation, architectural distortion, and honeycombing. Small perilymphatic nodules are not present and the pulmonary opacities are not cavitary. Mild symmetric peribronchial and mediastinal lymph node enlargement is present. The soft tissue windows show mild subcarinal (arrow) and symmetric bilateral (arrowheads) peribronchial lymph node enlargement. A small pericardial effusion (double arrowheads) is present.
A complete blood count showed a mildly elevated white blood cell count at 11.2 x 109 /L (normal, 4 - 10 x 109 /L), but with 20% eosinophilia at 12 × 109/L (normal, ˂0.45 × 109/). Serum chemistries and measures of renal function were within normal limits. Bronchoscopy was recommended to the patient, but she refused. Treatment of community-acquired pneumonia, presumably at least in part related to pertussis, was continued, as was oral corticosteroid therapy and inhalers for her asthma, but the patient still complained of shortness of breath and cough. Repeat thoracic CT (Figure 5) was performed less than one month following the previous thoracic CT.
Figure 5. Repeat thoracic CT, at about 6 months following initial presentation, and less than one month following the first thoracic CT. A-I: Representative images displayed in lung windows. J-O: Representative images displayed in soft tissue windows. Lower left: video of CT scan in lung windows. Lower right: video of CT scan in soft tissue windows.
Which of the following represents the most accurate assessment of the thoracic CT findings? (Click on the correct answer to proceed to the sixth of seven pages)