34 year old female with SOB and abnormal CT

This 34 year old female presented for evaluation with 2 months of increasing shortness of breath, chest tightness and cough.  There was minimal sputum production, but she is uncomfortable at night and had to sleep with 2 pillows.  Wheezing had been present but she did not respond to steroids, albuterol or Symbicort. Her lab data was normal except for a positive mono test.  She was not exposed to any aerosols.  She is a non-smoking, non-drug using female with 2 children living in a rural enviroment.

The CT images are shown:

What are possible diagnoses and how would proceed at this time

Diffuse Ground glass infiltrates

This is a 57 year old black female who had been a smoker but stopped 1 yr ago . She complained of increasing shortness of breath over 1 year.  She had undergone PFT’s that showed reduced FVC (59%) predicted and FEV1 (72% predicted).  Her total lung capacity was 71 % predicted.  She was unable to do a diffusion capacity.  The intial chest radiograph was read as normal.  Representative images from her CT scan are above

Do you think this is an abnormal scan? Would you perform a diagnositic procedure? If abnormal, suggest a diagnosis compatible with the CT scan.

 

Nodules that bleed

The prior benign nodule case was nodular amyloidosis.  Please read about the risk of bleeding and nodular amyloidosis under the case comments.  One of the DDx was an AVM  I include a recent patient with an AVM that was diagnosed many years ago and embolized recently.  The patient had some TIA’s which is a risk as is brain abscess.

Can one of the fellows write a brief review of sclerosing hemangiomas and find an image for me to publish? That was another popular dx.  LL had nodular amyloidosis in her DDx.