Correct!
4. 1 and 3
Pulmonary embolism and smoking can both mildly reduce the DLco (1,2). Pulmonary Langerhans cell histiocytosis has a variable appearance depending on the stage of disease, ranging from small peribronchiolar nodular opacities to multiple irregularly-shaped cysts (3). The earliest change is a diffuse bilateral reticulonodular pattern with a predilection for the mid and upper zones. Later, cyst formation may be seen or may mimic a honeycomb appearance due to a summation of air-filled cysts. Although the CT scan might be compatible with very early Langerhans cell histiocytosis, it is not characteristic.
Her symptoms of mild dyspnea on exertion persist and she is seen 5 years later. Physical examination is unremarkable and a serologic panel for rheumatologic disease is again normal. Her CT scan and pulmonary function testing are repeated (Figures 2 and 3).
Figure 2. Representative images from the thoracic CT scan in lung windows.
Figure 3. Repeat pulmonary function testing.
What should be done at this time? (Click on the correct answer to proceed to the third of five pages)