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1192 Radiology

A 38-year-old man is admitted with progressive shoness of breath and cough. He denies any fever, chills, or purulent sputum production. He wants to be evaluated to determine the reasons for his symptoms. On exam, he is afebrile and has decreased breath sounds with hyperresonant upper lung field more obvious on the right. ABGs on RA: pH 7.35; PCO2 38 mm Hg; PO2 78 mm Hg. Spirometry: FVC 1.72 (70% of predicted); FEV1 1.34 L (60% of predicted); FEV1/FVC% 76%; TLC 4.1 L (100% of predicted); TLC by helium dilution method 3.4 (71%); DLCO 70% of predicted. There is no bronchodilator response. Chest radiographs are shown below.What is the next management option?

APlace a chest tube urgently
BIncrease bronchodilator dosage and frequency
CSta chest physical therapy
DPerform CT scan of chest
Radiology
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