Correct!
1. Unenhanced chest CT shows new bronchovascular thickening and nodularity
Axial unenhanced chest CT again shows calcified left peribronchial and mediastinal lymph nodes with developing of bronchial wall thickening, particularly in the lingula and left lower lobe, with small associated nodules (arrowheads) suggesting bronchiolitis. No pleural or pericardial effusion is present. The inferior lingular consolidation appears somewhat bronchiectatic (arrows). Left peribronchial lymph nodes may be more prominent than the prior CT, but clear new bilateral peribronchial and mediastinal lymph node enlargement is not seen.
In the Emergency Room, the patient’s laboratory data included white count of 4.8 x 109/L (normal, 3.4 – 9.6 x 109/L) with a normal absolute neutrophil count of 2.77 x 109/L (normal, 1.4 – 6.6 x 109/L); hemoglobin of 9.1 gm/dL (normal, 13.2 – 16.6 gm/dL), hematocrit 26.2% (normal, 34.9 – 44.5%) and platelets of 151 x 109/L (normal, 149 – 375 x 109/L). An influenza swab was negative and coccidioidomycosis serologies were drawn. Liver function tests, lactic acid levels, and a serum glucose level were within normal limits. The patient’s creatinine was mildly elevated at 1.4 mg /dL (normal, 0.6 and 1.1 mg/dL). The brain natriuretic peptide level (BNP) was elevated at 1049 pg/mL (normal, <100 pg/mL); troponin levels were normal. The patients d-dimer level was elevated at 1700 ng/mL (normal, <500 ng/mL).
Based on the information thus far, which of the following is the most appropriate course of action? (Click on the correct answer to be directed to the eighth of 12 pages)