A high resolution CT of the chest was ordered next to help delineate the pattern of her lung disease better.
HRCT chest from May 29th
You can enlarge a PARTICULAR FRAME by clicking on that frame (above).
this entire CT by clicking here
The CT of the chest showed essentially the same findings as the CXR and confirmed the interstitial pattern. You can see that the disease is very generalized but now worse on the right side than on the left, with mediastinal shift to the right.
What investigation would you choose next to help diagnose her current illness?
Some physicians might choose a bronchoscopy and BAL to rule out infection. For a number of reasons, including the low yield of BAL in immunocompetent children, the high likelihood that she had an interstitial lung disease that requires histological diagnosis, and her small size necessitating a general anesthetic in the operating room in our center, we opted for an open lung biopsy via thorascopic technique. She also had a skin biopsy of the subcutaneous nodules and bone marrow aspirate and biopsy done at the same time.
NEXT I WILL SHOW YOU THE PATHOLOGY SLIDES