Correct!
2. Empiric treatment with voriconazole
The imaging was very suggestive of a mycetoma and the patient was thought to be at high risk for surgical resection and a bronchoscopic or CT-guided biopsy were considered high risk for pneumothorax, so the patient was treated empirically with voriconazole, although that was switched very shortly to itraconazole due to side effects.
The patient was followed closely with repeat CT imaging which showed a rapid resolution of both the intra-bulla mass and resolution of the bulla. Note that azole treatment was discontinued after 1 month due to rapid resolution of the opacity. The reasons for the resolution of the bulla are not certain, but blood can lead to a fibrotic response in the lungs which may have contributed to the resolution of the bulla.
Figure 5. Thoracic CT scan 1 month later.
Figure 6. Resolution by 4 months.
The most likely explanation for the resolution of the intra-bulla opacity is: (click on the correct answer to proceed to the fifth and final page)