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Assembly

A Batty Non-resolving Lung Abnormality

Authors
Xiao Wang, MD, Diagnostic Radiology Resident, University of Minnesota
Kexin Zheng, Swenson College of Science and Engineering, University of Minnesota, Duluth
Tadashi Allen, MD, Assistant Professor of Radiology, University of Minnesota


Case

A 21-year-old female with no significant past medical history presents with fever, dry cough and intermittent chest pain for 1 month. She is a college sophomore majoring in animal science. The patient was taking mammology and ornithology field classes and was bit by squirrel and exposed to ticks, but it seemed of little consequence. She did reported catching and handling bats in summer. She is a nonsmoker and denies any drug use. She has no exposure to tuberculosis, but volunteers in a homeless shelter.

Vital signs are: T 38.2 °C, BP 116/69, HR 119, RR 16, SpO2: 98 % on air. No respiratory distress. Normal breath sounds without wheezes or rales. WBC is 7,300 with unremarkable differential. The basic metabolic panel and liver function testing are all within normal limits. Tests for influenza, strep and HIV are all negative. A quantiferon gold test was also negative.

Images 1 & 2 - PA and lateral radiographs of the chest at time of presentation are shown.

Images 3-4 - Representative slices from the subsequent noncontrast chest CT are displayed.

Question

What is the most likely diagnosis?

A. Tuberculosis
B. Histoplasmosis
C. Klebsiella Pneumonia
D. Pneumocystis Pneumonia
E. Neoplasm

Answer