Correct!
1. The thoracic CT shows multifocal ground-glass opacity and consolidation, some of which is peripheral
The thoracic CT shows peripheral consolidation- areas of increased lung attenuation that obscures the margins of vessels and bronchi. Some of the opacities are ground-glass in attenuation also- areas of increased lung attenuation that does not obscure the margins of vessels and bronchi. Many of the opacities are frankly subpleural- so peripherally positions that the form a band-like opacity paralleling the chest wall immediately adjacent to the visceral pleural surface (Figure 3).
Figure 3. Panels A-D (left). Routine axial thoracic CT displayed in lung windows shows patchy areas of ground-glass opacity and consolidation (arrows) which is noticeably peripherally distributed. Panels E-J (right). Selected static images from the axial high-resolution thoracic CT again shows the peripheral and frankly subpleural consolidation (arrows), highlighting the upper lobe distribution.
Central peribronchovascular thickening is not a striking feature on the images provided. The opacities are clearly upper lobe predominant, as shown on the chest radiograph, and not lower lobe predominant. Peripheral endobronchial airway impaction typically presents with small centrilobular nodules, often with a branching configuration, commonly referred to as “tree-in-bud” opacity; such nodules are not present on these images. The images provided do not show multifocal ground-glass opacity nodules. The opacities on the CT study are not cavitary; air bronchograms are present, but cavitary necrosis is lacking.)
What is the appropriate next step for the evaluation / management of this patient?