Correct!
5. The serial thoracic CT scans show findings suggesting an inflammatory disorder progressing to fibrosis
The thoracic CT 6 years prior to presentation (Figure 3) shows inhomogeneous lung opacity, likely due to small airway obstruction, given the lobular configuration. The subsequent CTs show these same findings, but with the additional development of areas of ground-glass opacity and fine linear and reticular opacities (Figures 4 and 5), eventually progressing to features consistent with fibrosis (Figure 2); this sequence suggests an inflammatory disorder progressing to fibrosis. The serial CT scans clearly show a progressive abnormality, not a stable one. Fibrotic lung disease may be complicated by malignancy, but when this occurs, thoracic CT will commonly show multifocal or diffuse fibrotic-appearing abnormalities with a new or growing lung nodule or mass, possibly new or increasing lymph node enlargement, and such features are not present in this case. When fibrotic lung disease is complicated with a new inflammatory disorder, as may occur in patient with usual interstitial pneumonia / idiopathic pulmonary fibrosis with accelerated interstitial pneumonia, thoracic CT often shows areas of new ground-glass opacity and/or consolidation superimposed on features of fibrotic lung disease, such as reticulation, linear opacity, traction bronchiectasis, architectural distortion, and honeycombing; this sequence is more or less the reverse of the findings illustrated in the images presented.
A more focused history was taken. Which of the following would be the most likely relevant historical point discovered? (Choose the correct answer to move to the next panel)