T-fasteners for Preoperative Localization of Pulmonary Nodul

Case presentation
A 19 year-old male with a history of asthma presented with a 2-3 week history of persistent cough, 8% weight loss, fatigue and hypertension. A CT of his chest was performed showing interstitial reticular and nodular air space opacifications in the bases and lingula. Pulmonary function testing showed decreased pulmonary function with mild desaturations and an echocardiogram was normal. A flexible bronchoscopy with bronchoalveolar lavage (BAL) was performed and showed mild tracheomalacia and tongue base collapse. The BAL contained 400 nucleated cells per microliter, with a predominance of macrophages (83%), lipid content of questionable significance, and few neutrophils (Figures 1A and 1B). Cultures from the BAL grew only rare Streptococcus viridans and rare coagulase negative Staphylococcus which was consistent with oral flora. He was started on tiotropium and initially had improvement in his symptoms....