Correct!
5. All of the above.
Diffuse, bilateral symmetric lung opacities on chest radiography engender a very broad differential diagnosis, including all the entities listed. The differential diagnosis can often be narrowed through integration with clinical history and the time course of the development of the opacities.
The patient’s physician referred the patient to the emergency room, from which she was admitted to the hospital. The patient was tachypneic with room air oxygenation saturation of 89%. The white blood cell count was 16.8 x 1000 cells / μL with neutrophilia. The patient was initially diagnosed with severe community-acquired pneumonia and started on broad spectrum antibiotics. However, she continued to deteriorate clinically. One day after admission to the hospital, chest radiography (Figure 2) and thoracic CT (Figure 3) were performed.
Figure 2: Frontal chest radiograph performed on the second hospital day shows reduced lung volumes with progression of multifocal bilateral air-space opacities. Air bronchograms are now more readily visible in the upper lobes.
Figure 3: Representative slice from the thoracic CT performed shortly after Figure 2 shows symmetric, bilateral, diffuse air-space consolidation and ground-glass opacity. Small symmetric bilateral pleural effusions are seen. Mild smooth interlobular septal thickening is present.
Click here for a movie of the thoracic CT scan.
At this point, which of the following would be least likely to provide additional information regarding the etiology of this patient’s respiratory illness?
