Correct!
3. Neck CT

All of the choices listed would provide useful information for this patient, as would thoracic MRI. Surgical biopsy is, however, premature at this point. Similarly, 18FDG-PET is a bit premature, as the decision to obtain this study for the investigation of indeterminate lesions at chest radiography is often best informed following CT characterization. Prior chest radiographic comparison would prove useful here, particularly if the lesion was shown and unchanged on remote priors. However, in this case, this particular patient has progressive symptoms that could be related to this lesion, and therefore further investigation is warranted.

The patient underwent enhanced neck CT (Figure 5).

Figure 5. Axial (A) and coronal (B) enhanced neck CT.

Which of the following is the most appropriate description of this this patient’s CT findings? (Click on the correct answer to proceed to the seventh of nine pages)

  1. The enhanced neck CT shows a lesion arising from the esophagus
  2. The enhanced neck CT shows destruction of the tracheal wall
  3. The enhanced neck CT shows metastatic lymphadenopathy at the left thoracic inlet
  4. The enhanced neck CT shows that the lesion is a simple cyst
  5. The enhanced neck CT shows the lesion reflects a left subclavian artery aneurysm

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