Correct!
5. Assessment of serum total IgE, skin testing for hypersensitivity to Aspergillus fumigatus, and complete blood count
While active infection is not entirely excluded, the patient’s clinical history and the imaging findings are not directly suggestive of infection. Imaging with 18FFDG-PET scanning is unlikely to provide management-altering information- elevated tracer accumulation in the left lower lobe opacities would suggest and active inflammatory or neoplastic process, but lack of tracer accumulation would not provide an explanation for these opacities. Both bronchoscopy with bronchoalveolar lavage and biopsy and percutaneous transthoracic biopsy could provide a diagnosis for this patient, but may not be necessary, given that additional history and correlation with the CT findings may provide a presumptive diagnosis. Toward that end, evaluation of the complete blood count for possible peripheral eosinophilia, assessment of serum total IgE, skin and testing for hypersensitivity to Aspergillus fumigatus would prove useful before invasive measures are contemplated.
Based on the thoracic CT findings, additional history from the patient elicited asthma-like symptoms. The imaging findings of the various studies presented suggest which of the following diagnoses?