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Non-resolving consolidation — SCE Respiratory MCQ

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HardThoracic ImagingNon-resolving consolidationSCE Respiratory

A 72-year-old man has fever, weight loss and persistent left upper-lobe consolidation despite two antibiotic courses. CT shows mass-like consolidation with bulging fissure and low-attenuation areas. Sputum cultures are negative. What is the most appropriate investigation?

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Correct answer: D — Bronchoscopy with lavage and biopsy

Non-resolving lobar consolidation, especially mass-like in an older patient, requires bronchoscopy to exclude malignancy and obtain microbiology. Repeating antibiotics without tissue or airway assessment risks delay. Negative sputum cultures do not exclude cancer or atypical infection.

Reference: NICE NG122 Lung cancer; BTS bronchoscopy practice standards