Correct!
3. Thoracic CT shows progression of the anterior segment right upper lobe localized nodular opacities seen on the thoracic CT 2 months earlier (Figure 11)
The latest repeat thoracic CT (Figure 15) shows that the right upper lobe nodular consolidation has progressed slightly compared to recent CT examinations, and more obviously compared to remote priors, and now even shows a small focus of cavitation. No pleural disease, peribronchial or mediastinal lymph node enlargement, or new disseminated, small nodules are present. However, a number of nodules in the anterior segment of the right upper lobe as well as the right lower lobe, with branching configurations suggesting endobronchial impaction, are evident. Lower lobe opacities with the morphology of the bilateral lower lobe pneumonias seen on what by this point are comparatively remote CT examinations have not recurred.
The patient continued to intermittently present to his primary care physician for similar complaints of shortness of breath, cough productive of white sputum, dizziness, and dyspnea on exertion. During this time frame, the patient was also seen by a number of other consultants for additional complaints, including gastroenterology for dysphagia, otolaryngology for a lesion on his tongue diagnosed as a localized squamoproliferative lesion without dysplasia, general surgery for rib trauma after a mechanical fall, physical medicine for back pain, neurology for altered sensation of taste, and audiology for hearing loss, among others. He continually refused use of prednisone and azithromycin, claiming these medications make him “feel terrible,” nor did he follow the recommendations of his pulmonologist for optimized pulmonary toilet and maximization of this asthma therapy. One of his many complains included a 25 lbs. weight loss over the previous months, which was attributed to his dysphagia, but CT of the abdomen Figure 16) was obtained to assess for other causes.
Figure 16: Axial (top and middle row) and coronal (bottom row) images from an enhanced CT of the abdomen show multisegmental, non-contiguous areas of small bowel wall thickening and mucosal hyperenhancement (yellow arrowheads), particularly involving the terminal ileum (green arrowheads). Regional ileocolic lymphadenopathy (orange arrowheads) is present.
This study showed several short, inflamed segments of small bowel, particularly the terminal ileum.
Which of the following are appropriate differential diagnostic considerations for this patient’s condition? (Click on the correct answer to proceed to the eighteenth of nineteen pages)