Case 260 Medical History A 37-year-old male patient, unemployed, complained of functional class II dyspnea, adynamia, and dry cough for 6 months. Deny fever, weight loss and smoking. Normal physical examination. Patient was referred to the pulmonology service according to the images presented: Image 1: Chest X-ray, posteroanterior incidence. Image 2: High resolution computed tomography (HRCT) of the chest, coronal reconstruction in maximum intensity projection (MIP) technique, with no intravenous contrast.Image 3: High resolution computed tomography (HRCT) of the chest, sagittal reconstruction in MIP technique, with no intravenous contrast. Question:Based on clinical history and imaging findings, what is the most likely diagnosis and what is the next key step in the diagnosis? Silicosis; Investigate occupational history Miliary tuberculosis; Sputum smear microscopy Sarcoidosis; Mediastinal lymph node biopsy Pulmonary metastasis; Lung biopsy Time is Up! Time's up
