Medical history Female patient, 53 years old, former smoker, with diabetes and hypertension, admitted to the HC-UFMG complaining of non-productive cough, dyspnea on moderate efforts and low-grade fever, as well as weight loss (2 kg) in the last 2 months. Reports empirical treatment for atypical community-acquired pneumonia with azithromycin, after performing chest radiography (attached), about one month and a half ago, with no improvement. Physical examination shows SpO2 87% in room air and creptations in right infrascapular region. AFB smear research was done in the sputum, the first sample was negative. It was requested high resolution computerized tomography (HRCT), presented below. Image 1: Plain chest radiography in posterior-anterior viewImages 1 and 2: Plain chest radiography in right lateral viewImage 3: Chest computed tomography, high resolution technique without intravenous contrast. Axial section, subcarinal level, mediastinal windowImage 4: Chest computed tomography, high resolution technique without intravenous contrast. Axial section, lower level, lung window Question:What is the main diagnosis and the most appropriate management? Complicated Community acquired Pneumonia; thoracentesis for diagnosis. Pulmonary Tuberculosis; new request for AFB in sputum. Other than lung carcinoma small cell tumor; lung biopsy. Pneumocystosis; Pneumocystis jirovecii research in sputum. Time is Up! Time's up
