Correct!
2. Hamartoma
Among the choices offered, hamartoma is the most likely diagnosis. Adenocarcinoma-in-situ and lepidic-predominant adenocarcinoma are commonly slow growing lesions, but they present as subsolid nodules, lepidic predominant adenocarcinoma perhaps developing part solid components before becoming entirely solid, sometimes associated with cystic change or cavitation, and potentially showing lobulated or frankly spiculated margins. Lepidic predominant adenocarcinomas do not present as slowly enlarging solid nodules / masses. Coccidioidomycosis remains possible, but repeated serologic testing prior to this point has been negative, and the patient is not immunocompromised or diabetic, making it unlikely that fungal infection would achieve such a large size without causing systemic symptoms or being detected though repeated serology. Extralobar sequestration could present as a solid mass in this location but would be expected to be associated with anomalous systemic arterial supply and systemic venous drainage, neither of which are present.
The bronchoscopy showed extrinsic left lower lobe airway compression, acute inflammation in the lingula, and pathological findings suggesting hamartoma in the left lower lobe mass. The patient was treated with azithromycin and ceftriaxone with resolution of her chest pain and the lingular pneumonia.
Which of the following represents an appropriate step for the evaluation of this patient? (Click on the correct answer to be directed to the 16th of 17pages)