Correct!
5. Perform thoracic CT

Given the persistence of the left lower lobe opacity, negative testing for infections, and lack of fever and elevated white blood cell count, infection, while not entirely excluded, is increasingly unlikely; therefore, continued observation is not appropriate. Cardiac MRI would not be indicated for this patient. 68Ga – PET – CT dotatate scanning is typically used to stage neuroendocrine cell malignancies and would not clearly be of benefit for this patient at this point. 18FDG-PET scanning may be of benefit, but is usually most rewarding when interpreted in the context of dedicated anatomic imaging, typically thoracic CT; therefore, thoracic CT is the best answer among the choices offered.

The patient underwent unenhanced thoracic CT (Figure 5).

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Figure 5. A-I: Representative images from unenhanced thoracic CT, performed close to 6 months after initial presentation. Lower panel: video of thoracic CT in lung windows.

Which of the following represents the most accurate assessmentof the thoracic CT findings? (click on the correct answer to proceed to the seventh of eleven pages)

  1. The thoracic CT shows a left diaphragmatic hernia
  2. The thoracic CT shows a left lower lobe mass
  3. The thoracic CT shows focal left lower lobe bronchial obstruction
  4. The thoracic CT shows left lower lobe consolidation with central cavitation
  5. The thoracic CT shows new, loculated left base pleural effusion

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