2. Multiple pulmonary opacities

The chest is long and narrow but the lungs are not hyperinflated. The vasculature does not appear reduced and there is no evidence for flattening of the diaphragms although this is best seen on the lateral view. There are multiple pulmonary opacities of varying sizes and shapes present (Figure 2).

Figure 2. Chest radiograph with multiple pulmonary opacities (arrows).

What should be done next? (Click on the correct answer to be directed to the fourth of seven pages)
  1. Bronchoscopy with transbronchial biopsy
  2. Percutaneous needle biopsy
  3. Thoracic CT scan with contrast
  4. Thoracic CT scan without contrast
  5. Video-assisted thoracotomy (VATS)