Correct!
2. Frontal chest radiographic findings most likely represent fungal infection
The frontal chest radiograph shows right peribronchial and mediastinal lymph node enlargement associated with a medial apical right upper lobe nodule- such findings are not typical of viral infections, including COVID-19. While non-specific, these imaging abnormalities could be seen with fungal infection. Although sarcoidosis may produce both nodules and mediastinal and peribronchial lymph node enlargement, the lung nodules in sarcoidosis are typically much smaller- often less than 1 cm- and not solitary in nature, and the peribronchial lymphadenopathy is commonly symmetric, unlike the appearance in this case. Bacterial infection more commonly presents as consolidation, which is lacking in this case, and lymphadenopathy is not commonly seen at chest radiography.
Upon further questioning, the patient admitted to some shortness of breath, which lead to the ER staff obtaining a D-dimer level, which was elevated at 3341 ng/mL (normal, <500 ng/mL) which prompted CT pulmonary angiography (Figure 2).
Figure 2. Axial enhanced CT pulmonary angiography in the upper (A-C), Mid (D-F), and lower (G-I) lungs.
Which of the following represents an appropriate interpretation for this examination? (Click on the correct answer to be directed to the fourth of fourteen pages).