This is a 51 y/o woman followed in our office for moderate COPD. She continues to smoke and has had worsening dyspnea and weight loss for a couple months. Her CxR and CT scan, which in the past showed hyperinflation and nothing else, now have these pulmonary nodules.What is your DDx and wht would you do next?
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top of my differential includes both sarcoidosis and HP. although HP seems to be less common in smokers,these images are syuggestive of it. Infections (mycobacteria/fungus...), drug toxicity(amio/nitrofurantoin/others...if she is on any) can be placed on almost any differential diagnosis list. DIP is less likely (expect to see more ground glass..)
after obtaining a detailed history (including exposure, occupation, family history, meds, drugs...0, she will need bronch/TBBX to start with.
Addition to differential is malignancy. There is possible LAD that is present but difficult to see since no contrast. Also, this could look like lymphangitic spread.
She smokes. Consideration of RB-ILD. Infection i.e. histo. I suppose sarcoid but not hilar enlargement and ion wrong population/age group.
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