Correct!
4. Chest CT shows numerous, small, branching non-cavitary pulmonary opacities
The chest CT shows numerous small nodular opacities, many of which show a somewhat branching configuration, as well as multifocal mosaic perfusion. The small nodular opacities are widely distributed in a random fashion, but no evidence of cavitation is seen. No areas of ground-glass opacity or consolidation is present. The visible airways are not dilated. There are branching opacities, which raises the possibility of airway impaction, but clear evidence of bronchiectasis is lacking. There is no evidence of pleural thickening or effusion.
The patient’s shortness of breath was increasing and she was started on oxygen therapy and bilevel positive airway pressure (BiPAP). Laboratory data showed normal renal function, normal liver function, no anemia, and no evidence of an elevated white blood cell count. The report of an echocardiogram performed several months earlier showed normal left ventricular systolic function but right ventricular systolic pressure was estimated to be 70 mmHg.
Which of the following represents the most appropriate step in this patient’s management? (Click on the correct answer to proceed to the fifth of twelve pages)