Case 402

Medical history

6-year-old female patient admitted due to cough with purulent secretion for 2 weeks, fever, hypoxia, weight loss and 11% decline in FEV1 (forced expiratory volume in the first second). On physical examination: Respiratory Rate=30, Oxygen Saturation=96% in room air and bilateral coarse crackles on auscultation of the lungs. Previous diagnosis of cystic fibrosis, reports chronic cough. Chronically colonized by P. aeruginosa - positive culture of 3 weeks ago. Radiographs and high resolution computed tomography (HRCT) of the chest were requested.

Considering the clinical history and the imaging exams, which of the alternatives below describes the most appropriate medical approach?

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