Correct!
4. The thoracic CT shows bilateral basal low attenuation consistent with pulmonary parenchymal fat
The thoracic CT shows bilateral lower lung opacities consistent with a combination of ground-glass opacity and consolidation. In the denser consolidated areas, the soft tissue windows show low attenuation consistent with fat (Figure 3).
Figure 3. Axial thoracic CT shown in soft tissue (A-F) and lung (G-J) windows shows bilateral pulmonary parenchymal consolidation (arrows, G-J) in the right middle and lower lobes. The areas of consolidation are outlined in the soft tissue windows (A-F) and show that some of the consolidation consists of very low attenuation material. Note the resemblance of these areas to subcutaneous fat.
These areas consist of low attenuation, and not high attenuation, as may occur with amiodarone pulmonary toxicity. Through the demonstration of fat-containing pulmonary opacities, the CT adds significantly to information already known through chest radiography. The basal opacities could represent alveolitis, although there is relatively little reticulation and no hard features of fibrotic lung disease, such as honeycombing, traction bronchiectasis, or architectural distortion. Therefore, choice 4 is not the best answer. While the basal distribution of the opacities can be seen with aspiration pneumonia, centrilobular nodules, often seen with bronchiolitis in the setting of aspiration pneumonia, are not present.
What is the appropriate next step for the evaluation / management of this patient?