Part 2 for 26 y/o with asthma- with the conclusion

Here is part 2 for Asthma in a 26 y/o:
see the original case. I will also edit the original case to include this, but comments should be added here.

I was called by a prominant chest radiologist before I saw the patient. He told me that the patient had a left lower lobe pneumonia and possibly some central bronchiectasis. So, combined with his spirometry, I obtained studies to evaluate for ABPA (these were negative) and gave a burst and taper of prednisone for his untreated asthma. Because, clinically he had nothing to suggest a pneumonia, I ordered a CT scan.I saw him back in clinic 2 weeks later.

His PFT's had improved significantly:FEV1 up to 2.6 L (from 1.78). FVC was unchanged. His TLC was 74% predicted, and his DlCO was normal. His CT scan is shown:

So, now what?

PART 3:

We thought, given the mild eosinophila, his immigration history, and the cystic appearence on CT scan with what appeared to be multiple septae, that this could very well be an echinococcal cyst. Other possibilities included malignancy (esp sarcoma), or sequestration (although we did not identify a feeding vessel). I did not show it, but there was one 2 cm calcified lesion in the liver. So, I presented his case to thoracic surgery for primary resection. Our surgeons asked for an ID opinion, which was obtained. Although review of the literature showed that percutaneous drainage may be an option for hydatid cysts in the liver, this has not been shown in the lung. The ID consultants agreed with primary resection, but we chose to treat for 3 months with albendazole first.

Two weeks later, the story changed again. I was contacted by another radiologist (who had seen the initial CT scan in a conference). She sent me some computer reconstructions:

As seen, what we thought were septations were, in fact, vascular branches off of the left pulmonary artery. Additionally, she felt that the fluid density was not cystic (60 hounsfeld units). Now, the possibility of sarcoma came into play.

CONCLUSION: I showed these films to our thoracic surgeon, who again balked, so I rephrased the question. I asked him to name any potential diagnosis of this lesion for which resection was not appropriate management. The patient was taken to the OR 2 weeks later, and a left lower lobectomy was done.

Gross Path: multiple cystic lesions containing "thick green and brown material."
Microscopic Diagnosis: bronchiectasis with eosinophilic abscesses.

There were no parasites seen. There was no fungus. Cultures were negative.

I saw the patient in follow-up last week, and we are both dissapointed at the lack of a definitive etiology for all of this. He feels well, although he stopped taking his meds and his airways obstruction has significantly worsened. He is off of the albendazole, and we have chosen to follow-up clinically and with periodic imaging to identify any potential new lesions at an early timepoint.

Any other comments, thoughts, or suggestions?