Correct!
1. Chest CT
Among the choices listed, given the persistence of as yet unexplained symptoms, a repeat chest CT is reasonable and is the most appropriate among the listed choices. Echocardiography is probably of little value given the patient’s young age, lack of findings on imaging or laboratory data suggesting a cardiac etiology for the patient’s complaints, although it certainly would not be wrong to obtain cardiac functional evaluation in this setting. Upper endoscopy, however, is probably of little benefit as none of the patient’s symptoms or imaging findings have not been suggestive of a gastrointestinal abnormality. Surgical lung biopsy would certainly be of great help in determining the cause of the patient’s infiltrative lung abnormalities, but is needlessly invasive at this point as bronchoscopy has yet to be performed.
The chest CT was repeated (Figure 4).
Figure 4. A-C (left): Representative images from repeat axial unenhanced chest CT displayed in lung windows. Right: video of repeat axial CT displayed in lung windows.
Regarding the follow up chest CT (Figure 4), which of the following statements is most accurate? (Click on the correct answer to be directed to the ninth of fourteen pages)