Correct!
5. Video-assisted thoracoscopic surgical lung biopsy
A larger pulmonary tissue sampling procedure capable of providing histopathological analysis, such as video-assisted thoracoscopic lung biopsy, is the next most appropriate step. Cryobiopsy could be considered here as well but was not offered as a choice. 18FDG-PET scanning would add little management-altering information to this situation because whether or not the pulmonary opacities show elevated tracer utilization is irrelevant- a tissue sampling procedure is required for diagnosis at this point. Furthermore, 18FDG-PET scanning is typically employed for staging known or suspected malignancies or for characterization of indeterminate lung nodules, and neither situation is the case here. Open surgical lung biopsy is not a good choice as the desired information can be obtained through video-assisted thoracoscopic lung biopsy with less expense and morbidity. Repeating either the chest CT or bronchoscopy is unlikely to add new or management-altering information at this juncture.
The patient underwent video-assisted thoracoscopic lung biopsy which showed acute and organizing lung injury with interstitial edema, type II pneumocyte hyperplasia, intra-alveolar fibrin deposition, acute fibrinous pneumonitis, lipid-laden macrophages, and foci of organizing pneumonia, associated with an inflamamtory cellular infiltrate composed of neurtrophils and lymphocytes. Finely vaculoated foamy macrophages with similar foamy change in the cytoplasm of type II pneumocytes were also present.
At this point, which of the following represents most likely diagnosis for this patient? (Click on the correct answer to be directed to the thirteenth of fourteen pages)