Correct!
2. Percutaneous biopsy of the renal lesion
Among the choices listed, percutaneous biopsy of the left renal lesion is the least invasive and most likely to provide a tissue diagnosis. Often percutaneous renal biopsy is performed in the context of a solid-appearing renal lesion to assess for malignancy, not infrequently in combination with percutaneous ablation techniques. In this case, percutaneous sampling solely for diagnosis would be the procedure performed. Repeating bronchoscopy would likely not be of benefit, even with the addition of navigation and endobronchial ultrasound, when the first bronchoscopic procedure adequately sampled the lesion but failed to obtain a tissue diagnosis. Retrograde ureterography can be performed to examine the renal collecting system and urothelium and obtain cytology for examination, typically for malignancy, but the renal lesion in this case is not within the collecting system, and therefore this procedure would have a reduced diagnostic yield. Video assisted thoracoscopic biopsy of the right lung lesion is technically feasible and would obtain a tissue diagnosis, but is a more aggressive approach than percutaneous biopsy of the renal lesion, or, for that matter, percutaneous transthoracic needle biopsy. Similarly, laparotomy could provide material sufficient for diagnosis if disease in the retroperitoneum that is accessible is identified, but the renal lesion is, by definition, a retroperitoneal organ and may therefore not be readily accessible through this approach.
The patient underwent percutaneous fine needle aspiration and core biopsy of the left renal mass.
Among the choices listed, which is the most likely diagnosis to explain the renal, aortic, and lung lesions? (Click on the correct answer to proceed to the seventh and final page)