Correct!
4. Chest CT radiography suggestive of post-obstructive pneumonia
The CT pulmonary angiography examination shows focal, somewhat mass-like, consolidation restricted to the superior segment of the left lower lobe. Mild presumably reactive left peribronchial lymph node enlargement is also present. Calcified left peribronchial lymph nodes are also seen. An aerated left lower lobe superior segmental bronchus is not visible; rather, a tubular-shaped opacity is present in the location of the superior segmental bronchus, with a small focus of calcification at the orifice of the bronchus. These findings are seen to advantage using multiplanar reconstructions (Figure 6).
Figure 6. Oblique axial (A), sagittal (B) and coronal (C) CT multiplanar reconstructions show the tubular-shaped, impacted superior segmental left lower lobe bronchus (curved arrows) extending into consolidation (*) to advantage. A focus of calcification (A, arrowhead) is present at the origin of the superior segmental left lower lobe bronchus. The impacted left lower lobe superior segmental bronchus is seen en face in the coronal projection (arrow, C).
While the focal lung opacity is non-specific and could technically represent bacterial pneumonia, fungal pneumonia, or neoplasm, the impacted bronchus leading to the consolidation suggests an obstructive etiology. There is no visible fat within the focal lung opacity to suggest exogenous lipoid pneumonia.
Based on the findings at CT pulmonary angiography, which of the following represents an appropriate next step for the evaluation of this patient? (Click on the correct answer to be directed to the eighth of 11 pages)