Radiologic Findings

A frontal radiograph shows innumerable small nodules scattered fairly evenly throughout both lungs.

 

A

CT (A and B) shows multiple, bilateral, parenchymal nodules without any large, primary, mass lesion. There is no cavitation of the nodules, some of which appear to have a perivascular distribution. Pleural effusion and hilar adenopathy are absent. The liver (not shown) was normal. A CT of the pelvis showed a round, calcified nodule consistent with a leiomyoma of the uterus that was first noted at a C-section performed 14 y ago at the birth of her only child.

B

Consider both of these questions before clicking on the answer. The most likely diagnosis is:

Infectious granulomatous disease

Sarcoidosis

Metastatic neoplasm

Diagnostic procedures and their order might include:

Sputum for organisms

Bronchoscopy, BAL, and transbronchial biopsy

Bronchoscopy and BAL

Thoracoscopic or open lung biopsy

Skin tests for tuberculosis and fungal diseases

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Answer: All of the diagnoses listed are possible.

Diagnostic procedures and their order might include:

Sputum for organisms

Bronchoscopy, BAL, and transbronchial biopsy

Bronchoscopy and BAL

Thoracoscopic or open lung biopsy

Skin tests for tuberculosis and fungal diseases

Answer: Diagnostic procedures in the order performed were as follows:

1. Skin tests with PPD and coccidioidin were applied and were negative.

2. She underwent bronchoscopy with BAL and transbronchial biopsy, which did not yield a diagnosis.

3. Histologic sections of the video-assisted thoracoscopic biopsy follow.

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