Correct!
5. 1 or 3
Among the choices listed, the next step in management is a “close call”- both “1” and “3” are good choices. On the one hand, it could be argued that 18FDG-PET scan could be used to characterize the abnormal right peribronchial and mediastinal soft tissue and potentially detect additional sites of metabolically active abnormalities to target biopsy, particularly in light of the thoracic CT findings of abnormal right peribronchial and mediastinal soft tissue- perhaps the 18FDG-PET scan could disclose other more accessible abnormalities that would allow a diagnosis. On the other hand, it could be argued that the results of the 18FDG-PET scan are irrelevant- the abnormal soft tissue in the abnormal right peribronchial and mediastinal soft tissue has been well-shown and CT and requires a tissue diagnosis regardless of the 18FDG-PET scan findings. Video-assisted thoracoscopic tissue sampling would be capable of obtaining tissue for a definitive diagnosis, but it unnecessarily invasive at this point in the patient’s evaluation. Dynamic contrast-enhanced thoracic MR (and CT) is a technique primarily used for characterization of indeterminate solitary pulmonary nodules and is not applicable to the patient.
At this point, which of the following is the least likely etiology for the patient’s imaging findings? (Click on the correct answer to proceed to the seventh of nine pages)