Correct!
2. Pneumonia
In outpatients who present for thoracic imaging with relatively acute onset of respiratory symptoms, pulmonary infection is the most likely cause for a poorly defined focal pulmonary opacity. The ill-defined focal nature of the process at chest radiography would be a highly unusual manifestation of ovarian malignancy. Ovarian malignancy often presents in the thorax with pleural abnormalities, or perhaps lymph node enlargement or lung nodules, typically in the context of subdiaphragmatic disease. Pneumonitis related to radiotherapy, with or without concomitant chemotherapy, may present with focal lung opacity, but the history specifically states that the patient’s ovarian malignancy is in remission, so this potential etiology is not a consideration. Pulmonary contusion often presents with peripheral lung opacity, but no history of thoracic trauma is given. Finally, pulmonary abnormalities in the context of thromboembolic disease, such as atelectasis, pulmonary hemorrhage, or pulmonary infarction, may present with peripheral lung opacities, but such processes are less common than pulmonary infection).
Clinical course: Previous chest radiographs performed approximately 1 year earlier (Figure 2) were obtained for comparison.
Figure 2. Frontal and lateral chest radiographs performed over 1 year prior to presentation imaging (Figure 1).
Which of the following statements regarding the chest radiograph is most accurate? (Click on the correct answer to proceed to the fourth of nine panels)