Correct!
1. Bronchoscopy with transbronchial biopsy
Repeat pulmonary CTA is unlikely to provide additional data as the right upper lobe opacity has been repeatedly imaged and has shown progression, and the morphology of the process is not suggestive of thromboembolic disease. Both open surgical lung biopsy, and, even more so, video-assisted thoracoscopic biopsy, are reasonable choices, but are needlessly invasive as the diagnosis may potentially be established with bronchoscopy and transbronchial biopsy. Cryobiopsy may eventually play a role for the diagnosis of localized pulmonary opacities, but the limited data for this procedure currently suggests that the primary application of this procedure is in the diagnosis of diffuse fibrotic lung diseases.
The patient underwent bronchoscopy with transbronchial biopsy, which showed a single fragment of alveolar parenchyma without pathologic abnormality. No granulomas, other features of sarcoidosis, viral inclusions, or fungus was seen.
At this point, which of the following represents the most appropriate step in this patient’s management? (Click on the correct answer to proceed to the fifteeenth of nineteen pages)