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1. Community-acquired pneumonia
While the imaging findings are relatively non-specific, community-acquired pneumonia is the most likely diagnosis, if for no other reason than community-acquired pneumonia is probably the most common etiology for new onset multifocal pulmonary opacities. Primary pulmonary malignancies, including adenocarcinoma and lymphoproliferative disease, may present with multifocal pulmonary opacities, but multifocal lung disease is a rare manifestation of primary malignancy and does not typically present with a relatively acute onset, and is most commonly diagnosed when multifocal pulmonary opacities persist on follow up imaging after presumptive treatment for pneumonia fails to result in resolution of pulmonary opacities at chest imaging. The imaging features of post-acute COVID-19 infection are protean, ranging from nearly normal-appearing CT scans to multifocal areas of reticulation and ground-glass opacity [typically band-like in morphology], and even features that suggest overt fibrosis. The pulmonary opacities on this patient’s CT have an appearance more suggestive of relatively acute infection or exudative acute lung injury, rather than the residua of a previous inflammatory or infectious disorder.
The patient was diagnosed with suspected pneumonia, presumably community-acquired, with bacterial or viral etiologies considered most likely. Testing with a viral respiratory panel was negative, including testing for COVID-19. Other supportive respiratory therapies were instituted as well. The patient remained afebrile. Her shortness of breath and cough subjectively improved, but did not completely resolve. Repeat frontal chest radiography (Figure 3) was performed 1 week following presentation.
Figure 3. Repeat frontal chest radiography performed one week following presentation after empiric antibiotic therapy for presumed bacterial community-acquired pneumonia.
Which of the following represents an appropriate interpretation for this examination? (Click on the correct answer to be directed to the fifth of 11 pages)