Correct!
4. Consult thoracic surgery for potential resection
Rigid bronchoscopy is a consideration but the lesion, and potential complications, would be better controlled with a surgical approach. Cryobiopsy would not be useful for this patient’s lesion, and is typically reserved for sampling of diffuse interstitial lung diseases. Bronchoscopy with lasers may be useful for fibrous bronchial stenoses or treatment of neoplasms, but the nature of the obstruction in this patient would not necessarily be conducive to laser therapy. Furthermore, the bronchoscopic procedure already resulted in hemorrhage, and therefore an approach using direct control of the area is warranted.).
Thoracic surgery was consulted. The surgeon considered a minimally invasive approach, a robotic approach, and the possibility of superior segmentectomy, but the proximal nature of the obstruction precluded placing a stapler across the left lower lobe superior segmental bronchus and therefore excluded the possibility of segmentectomy. Furthermore, owing to the normally close apposition of the segmental artery and bronchi, and that in this patient this close relationship would be obliterated by inflammation, a minimally invasive approach was considered to likely be unsuccessful. Therefore, the decision was made to plan for an open surgical procedure.
Which of the following represents the most likely diagnosis for the patient’s condition? (Click on the correct answer to proceed to the tenth page)