Correct!
3. VATS lung biopsy
Cryptogenic organizing pneumonia is a nonspecific diagnosis (4). The patient was unsatisfied with the diagnosis and she had been treated with corticosteroids without improvement. In our experience a second bronchoscopy is usually no helpful if the first is nondiagnostic. For these reasons it was decided to proceed to a video-assisted thorascopic (VATS) biopsy. The histology is shown in Figure 3.
Figure 3. Representative H & E microscopic images from the VATS lung biopsy at low (A), intermediate (B,C) and high power (D).
The biopsy was interpreted as showing acute lung injury, predominantly comprised of organizing diffuse alveolar damage and organizing pneumonia. There were collections of intra-alveolar foamy macrophages. No evidence of infection or silicone emboli were noted. Drug reaction, systemic connective tissue disorder, septicemia, noxious inhalants, sepsis/shock or in the idiopathic setting in acute interstitial pneumonia were listed as the most likely diagnosis.
Which of the following is the most likely diagnosis? (Click on the correct answer to be directed to the sixth of seven pages)