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1. Bronchoscopy with EBUS

Bronchoscopy might be a simple and the least invasive way of making a diagnosis. VATS still seems overly aggressive when bronchoscopy has a reasonable expectation of making a diagnosis. Pulmonary angiography is usually reserved for pulmonary vascular disease, especially pulmonary embolism. There is no reason to suspect pulmonary embolism based on his clinical course or radiology.

A bronchoscopy with transbronchial biopsy was performed with endobronchial ultrasound (EBUS) lymph node biopsy. Both showed nonspecific findings. The EBUS showed lymphocytes at station 7 which were not abnormal. The transbronchial biopsy showed a few hemosiderin-laden alveolar macrophages with some features of organizing pneumonia. Needle biopsy was recommended but the patient refused.

Which of the following are indicated at this time? (Click on the correct answer to be directed to the fifth of eight pages)

  1. Begin fluconazole while awaiting the coccidioidomycosis serology
  2. Begin itraconazole while awaiting the histoplasmosis serology
  3. CT/PET scanning
  4. 1 and 3
  5. All of the above

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