Correct!
4. 1 or 3
In our experience, a repeat bronchoscopy is rarely diagnostic when the first bronchoscopy does not provide a specific diagnosis. The patient was reluctant to undergo VATS and chose to seek a second opinion. A consulting pulmonologist also recommended VATS which was performed. The biopsy showed patchy interstitial pneumonia and associated chronic broncholitis (Figure 2).
Figure 2. Histology of VATS lung biopsy. A: Low power view demonstrating patchy consolidation with adjacent interstitial infiltrates. B: Intermediate magnification showing an inflammatory process accentuating the centrilobular zone. PA=pulmonary artery. C: Higher magnification showing a prominent chronic inflammatory population admixed with vacuolated macrophages. D: High power magnification of the inflammatory infiltrate showing plasma cells, lymphocytes and aggregates of macrophages. To view Figure 2 in a separate, enlarged window click here.
The pathologist thought the biopsy was most consistent with hypersensitivity pneumonitis (HP) (3).
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