Correct!
1. Chest CT shows no change in the right pleural effusion
Repeat unenhanced chest CT shows no clear change with the right pleural effusion, again with mild smooth pleural thickening. No evidence of new pleural nodularity is seen, nor is increasing / new mediastinal or peribronchial lymph node enlargement present. No left pleural effusion is present, and no evidence of right pleural space gas to indicate bronchopleural fistula is seen.
Autoimmune serologies disclosed a cyclic citrullinated peptide (CCP) antibody level of >250 U (normal, <20 U), normal antibodies to extractable nuclear antigen, including SS-A/Ro, SSB/La, Sm, and RNP. Scl 70 and Jo 1 antibodies were unremarkable. Rheumatoid factor was mildly elevated at 17 IU/mL (normal, <15 IU/mL). Myeloperoxidase and proteinase-3 antibody levels were normal. Antinuclear antigen antibody was 1:80 (negative <1:80). The Myomarker profile was negative.
Based on the information thus far, which of the following represent likely diagnoses for this patient? (Click on the correct answer to be directed to the sixteenth of seventeen pages)