Correct!
4. Sarcoidosis

Among the possibilities listed, sarcoidosis is the only disorder that is typically upper lobe predominant; the other conditions are typically either basal predominant (usual interstitial pneumonia, asbestosis, chronic aspiration) or diffuse (desquamative interstitial pneumonia) in distribution. Additionally, sarcoidosis often appears more nodular, rather than reticular or linear, although later stage sarcoidosis, when complicated by fibrosis, may have a radiographic appearance dominated by linear and reticular opacities with architectural distortion.

The patient underwent thoracic CT (Figure 2) for further characterization of the chest radiographic findings.

Figure 2. Panels A-D. Representative static thoracic CT displayed in lung windows. Lower panel: movie of thoracic CT scan displayed in lung windows.

Which of the following statements regarding this CT examination is most accurate? (Choose the correct answer to move to the next panel)

1. The thoracic CT shows a fibrotic process distinct from most idiopathic interstitial pneumonias
2. The thoracic CT shows features characteristic of smoking-related interstitial lung disease
3. The thoracic CT shows features strongly suggesting lymphangitic carcinomatosis
4. The thoracic CT shows findings characteristic enough of usual interstitial pneumonia / idiopathic pulmonary fibrosis that surgical biopsy may be deferred
5. The thoracic CT shows findings suggesting active infection

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