Correct!
2. Bronchoscopy with endobronchial ultrasound biopsy
The thoracic CT scan shows multiple masses within the mediastinum. These should be accessible to needle biopsy through the bronchus or trachea with a bronchoscope. Mediastinoscopy would also be acceptable in obtaining a diagnosis but bronchoscopy is simpler and does not require general anesthesia. There are no striking abnormalities in the lung, pleural effusion or pulmonary embolus identified so choices 1, 4, and 5 are not appropriate.
Bronchoscopy was performed and surprisingly two masses were seen in the trachea and the right mainstem bronchus which were biopsied (Figure 4).
Figure 4. Panel A: view from the trachea showing tracheal lesion and right mainstem bronchus lesion (arrows). Panel B: view from just above the main carina showing right mainstem bronchus lesion.
An EBUS with biopsy was performed (Figure 5).
Figure 5. Endobronchial ultrasound showing needle biopsy of mediastinal mass.
Which of the following is the most likely diagnosis? (Click on the correct answer to proceed to the fifth and last panel)