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5. Frontal and lateral chest radiography shows upper lobe bilateral linear and reticular abnormalities

On initial review the frontal and lateral chest radiographs superficially appear normal. There is no evidence of peribronchial or mediastinal lymph node enlargement, the lung volumes appear normal, and the heart size is normal. However, upon close inspection, faint reticular and nodular opacities are visualized in the upper lobes bilaterally in a fairly symmetric fashion (Figure 2).

Figure 2. Close up of frontal radiograph. Faint, symmetric, bilateral upper lobe reticular and nodular opacities (arrowheads) are present.

The patient’s past medical history was unremarkable- no history of diabetes, heart disease, or malignancy was noted. Approximately a year earlier, she had experienced a chemical burn at her employment that involved her hands, but seemed to extend more proximally along her arms, and involved her thighs and legs as well. The skin affected showed peeling, and persisted, eventually transitioning to a white, popular, pruritic rash. She was a lifelong non-smoker.

Which of the following would be most useful for the evaluation of this patient? (Click on the correct answer to procced to the third of seven panels)

  1. Dermatologic consultation
  2. Flexible fiberoptic bronchoscopy
  3. Pulmonary function testing
  4. Repeat frontal chest radiography
  5. Right heart catheterization

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