Correct!
1. Obtain video-assisted thoracoscopic surgery; or 3. Perform bronchoscopy; or 5. Perform percutaneous transthoracic needle biopsy of the left lower lobe process
While open surgical lung biopsy is needlessly invasive, performing bronchoscopy, video-assisted surgical lung biopsy, or percutaneous transthoracic needle biopsy are all relatively appropriate choices for obtaining tissue in this patient, although bronchoscopy is probably the favored choice. Pleuroscopy is useful for assessment of pleural effusions or pleural masses, but neither are present in this patient. The Chamberlain procedure can be useful for sampling left para-aortic, anterior mediastinal, prevascular, and subaortic lesions, including lymph nodes in these stations, but the subaortic lymph node in this patient was only borderline-enlarged at CT and not metabolically active at 18FDG-PET, and probably is not an appropriate target for obtaining a tissue diagnosis.
The patient’s cough persisted relatively unchanged. She underwent repeat thoracic CT (Figure 7).
Figure 7. Panels A-G: Representative images from an unenhanced thoracic CT performed nearly 12 months after initial presentation. Panels H-J are images from the previous thoracic CT (Figure 5), performed nearly 6 months earlier. Lower panel: video of thoracic CT in lung windows.
Which of the following represents the most accurate assessment of the thoracic CT findings? (Click on the correct answer to proceed to the tenth of eleven pages)