Does this mean pulmonary fibrosis? Indication: PROGRESSIVE SHORTNESS OF BREATH/ PE PROTOCOL  Biopsy- Fragments of fibroconnective tissue with myxoid changes, no malignancy is identified. No lung parenchyma is present. Indeterminate cellularity, adequacy dependent on clinical/radiological certainty of representative sampling (if representative, favor benign) Acute inflammation and fibrosis CT Scan- 1. The progressive opacities in the right upper lobe are concerning for malignancy versus progressive atypical pneumonia versus drug toxicity.  2. The pulmonary nodules remain stable in appearance.  3. No evidence of pulmonary embolus  Pleura: Right pleural effusion is stable. There is mixed attenuation within the fluid, which could be due to tumoral involvement versus infection.  Lungs: There is progressive opacity in the right upper lobe (series 3, image 33). Given the increase in these findings and negative cultures per the clinical notes, this is concerning for lung malignancy. Differential consideration would include pneumonia or drug toxicity. The opacities in the left lung remains stable. The bilateral pulmonary nodules remain stable in appearance (series 3, images 72, 75, 78, for example) and may represent sequelae of granulomatous disease.. There is stable consolidation in the right lower lobe, likely atelectasis, as a result of the right pleural effusion.  Mediastinum/Lymph nodes: Prominence mediastinal lymph nodes are again identified, which may relate to known acute lymphoblastic leukemia.