Correct!
1. The thoracic CT shows basal linear and hyperattenuating nodular interstitial thickening
Thoracic CT shows basal predominant linear opacities associated with small, circumscribed nodules; the wide window width images (Figure 3J-Q) show that some of the nodular opacities are hyperattenuating, suggesting calcification or ossification. The opacities are not predominantly distributed in the subpleural regions of lung, nor is there honeycombing or intralobular interstitial thickening; the lack of these findings and the lack of the clear, basal and subpleural predominance of the findings argues against the diagnosis of UIP / IPF. While nodules are present, they are distributed in a patchy, peribronchovascular and interstitial manner, not the random pattern typical of a miliary distribution. The nodules do not show the branching morphology characteristic of “tree-in-bud” opacities. Bronchiectasis is not evident.
What is the appropriate next step for the evaluation / management of this patient?