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5. Thoracic CT
Bronchoscopy is a reasonable consideration, but useful information may be gained through non-invasive evaluation with thoracic CT. 18FDG-PET scanning is premature at this point; typically, this procedure is performed to stage malignancies or assess solitary pulmonary nodules, and is generally most rewarding in the latter context after thoracic CT has been performed and returned indeterminate results. Contrast-enhanced MRI is most commonly used for musculoskeletal applications or for assessment of mediastinal or vascular disorders and is generally less efficacious that thoracic CT for evaluation of lung abnormalities. 133Xe-Ventilation – 99m Tc-perfusion scintigraphy could demonstrate the presence of either airway or vascular abnormalities contributing to the chest radiographic abnormalities, but often the findings at ventilation / perfusion scintigraphy are relatively non-specific and require interpretation in light of information from anatomic studies. The chest radiographic findings are not suggestive of thromboembolic disease, so 133Xe-Ventilation – 99m Tc-perfusion scintigraphy’s role in the evaluation of that disorder is not relevant for this patient.
The patient underwent unenhanced and enhanced thoracic CT for further investigation of the chest radiographic findings (Figure 2). Editor's note: the video files are large and may take some time to open.
Figure 2. A-I: Representative images of axial contrast-enhanced thoracic CT displayed in lung windows. J-O: Representative images from soft tissue windows. Lower left: video of axial contrast-enhanced thoracic CT in lung windows. Lower right: video of axial contrast-enhanced thoracic CT in soft tissue windows.
Which of the following statements regarding this imaging study is most accurate? (Click on the correct answer to proceed to the fifth of eight pages)