Correct!
4. The chest CT shows numerous small, circumscribed pulmonary nodules
The axial enhanced chest CT shows mildly enlarged lymph nodes, particularly in the left supraclavicular zone, corresponding to the metabolically active lymph nodes seen at 18FDG-PET scan as well as numerous bilateral, small, circumscribed pulmonary nodules. No features to such fibrotic disease, such as honeycombing, traction bronchiectasis, and architectural distortion, are present. While small right-greater-than-left pleural effusions are present, no pleural thickening is evident. Small circumscribed pulmonary nodules are present, but no significant ground-glass opacity or consolidation is seen right basal passive atelectasis adjacent to the right pleural liquid is noted]. The main pulmonary artery is normal in size, so there is no CT evidence of pulmonary hypertension.
Pulmonary Medicine was consulted and performed bronchoscopy. Visual inspection at bronchoscopy was unrevealing and testing for bronchoalveolar lavage fluid for various respiratory pathogens, including acid-fast bacilli, was negative. The patient’s Quantiferon test returned positive, and was repeated, and was positive a second time. Outside medical records were obtained that revealed that the patient’s Quantiferon test was negative about one year earlier, performed prior to initiation of adalimumab therapy.
Which of the following represents the most appropriate recommendations for the patient’s management? (Click on correct answer to be directed to the tenth and final page)