Correct!
3. The thoracic CT shows that the tubular opacities on the chest radiograph represent dilated and tortuous peripheral pulmonary vessels
The enhanced thoracic CT shows numerous dilated and tortuous vessels extending to the subpleural regions of lung. Note that rather large vessels can be seen in direct contact with the visceral pleura, particularly well seen on the images shown in lung windows (Figure 3, Panels F-H). These structures clearly enhance and therefore are vessels, not bronchi; therefore, bronchial impaction and an airway etiology for the tubular abnormalities seen on the chest radiograph are excluded. There is no large, anomalous vessel emanating from the cranial abdominal aorta supplying the lower lobes, as can be seen with anomalous systemic arterial supply to the lower lobes. Peripheral pulmonary arteriovenous malformations remain a consideration, but the characteristic morphology at CT that allows their recognition- a vascular nidus supplied by one or more enlarged pulmonary arteries and drained by an enlarged pulmonary vein- is not seen on the images provided. Rather, a diffuse enlargement of peripheral pulmonary arteries and veins is seen.
What is the appropriate next step for the evaluation / management of this patient?