Correct!
5. More than one of the above
Given the persistent lung opacity and elevated antinuclear antibody level, rheumatologic consultation is appropriate. Similarly, bronchoscopy with lavage and tissue sampling could be performed to evaluate the persistent lung opacities, given that viral testing has been unrevealing and broad-spectrum antibiotic therapy has been instituted without improvement in the pulmonary opacities. Consultation with gastrointestinal medicine is appropriate given the history of reflux disease and the apparent exacerbation of her respiratory condition recently.
Repeat COVID-19 testing was negative, but Paxlovid (Nirmatrelvir & Ritonavir) therapy was instituted anyway given some concern for post-acute COVID-19 syndrome. Rheumatology evaluated the patient and found no clinical or other serological evidence of an autoimmune condition. Gastrointestinal medicine evaluated the patient and felt that she was stable on her Omeprazole therapy. The patient underwent repeat chest CT (Figure 5), 6 weeks following Figure 4 (first outpatient follow up) and 18 weeks following her initial presentation CT (Figure 2).
Figure 4. Left (A-D): Representative images from the unenhanced chest CT performed 3 months following initial presentation. Right: Video of chest CT.
Which of the following represents an appropriate interpretation for this examination? (Click on the correct answer to be directed to the tenth of 11 pages)