Correct!
2. Bronchoscopy with bronchoalveolar lavage
A repeat CT of the chest will add little to what is already known from the evolution of the pulmonary opacities on the previous three chest CTs, particularly given that neither the patient’s presentation and evolution, nor her imaging findings, are suggestive of pulmonary vascular disease or thromboembolic disease. 18FDG-PET scanning would add little management-altering information because whether or not the pulmonary opacities show elevated tracer utilization is irrelevant- a tissue sampling procedure is required for diagnosis at this point. Given that the patient has no extrathoracic complaints and her clinical course has been entirely related to abnormalities in the lung parenchyma, it is unlikely that 18FDG-PET scanning will show unsuspected foci of extrapulmonary tracer uptake that could provide a target for intervention. Pleuroscopy is not indicated given that the patient’s abnormalities are entirely pulmonary parenchymal- none of her 3 chest CTs have shown a pleural abnormality. Video-assisted thoracoscopic lung biopsy would be capable of providing sufficient tissue for a diagnosis, but is overly invasive given that bronchoscopy with bronchoalveolar lavage may be capable of providing the correct diagnosis in a less invasive manner. The patient underwent bronchoscopy (Figure 8) with bronchoalveolar lavage and cryobiopsy, which showed areas of organizing pneumonia with abundant eosinophils.
Figure 8. Bronchoscopy with bronchoalveolar lavage and cryobiopsy. No central airway abnormalities were noted.
No hyaline membranes were seen and no organisms were found.
Which of the following represents the correct diagnosis for this patient? (Click on the correct answer to be directed to the twelth and final page)