Correct!
1. Obtain 18FDG-PET scan or 4. Perform percutaneous transthoracic needle biopsy of the left lower lobe process
Among the choices listed, obtaining 18FDG-PET scan is most appropriate. Repeating the thoracic CT as a high-resolution CT [HRCT] protocol would be of little benefit. HRCT is a “sampling” technique, typically used for the assessment of diffuse lung disease, not focal lung opacities, as seen in this patient. Video-assisted thoracoscopic surgery [VATS] could be of benefit in this patient, but is probably overly-invasive- other less invasive and less expensive options for establishing a diagnosis for this patient exist. Endoscopic ultrasound, however, is not one of them- this procedure may be of diagnostic utility if the targeted lesion is in close proximity to the esophagus or stomach, which is not the case for this patient. Percutaneous transthoracic fine needle biopsy could potentially establish a diagnosis for this patient and is not an inappropriate choice, but among the invasive procedures that could be used to assess this patient, bronchoscopy- which was not offered as one of the choices listed- would probably be the best procedure.
18FDG-PET scan (Figure 6) was performed.
Figure 6. 18FDG-PET shows no significant tracer accumulation within the region of left lower lobe consolidation. The borderline enlarged subaortic lymph node (arrow) seen at thoracic CT shows no significant tracer accumulation.
This study showed no clearly significant tracer utilization within the left lower lobe cavitary opacity, the left apical nodule, or mediastinal lymph nodes.
Which of the following represents the most appropriate next step for the management of this patient? (Click on the correct answer to proceed to the ninth of eleven pages)