Correct!
5. Perform thoracic CT
Given that some time has lapsed since the previous chest imaging showing an abnormality, and several medical interventions have been performed in the interim, it would be wise to repeat he chest imaging. This could be done with repeat chest radiography, but given the patient’s already somewhat complicated course, thoracic CT would be preferable. Because the patient’s clinical presentation and imaging findings have been primarily pulmonary, thoracic MR would be a less optimal approach to chest imaging than chest CT in this patient. As discussed previously, 18FDG-PET scan would likely not provide management-altering information for this patient at this point, and typically 18FDG-PET scanning is most useful when characterization of chest imaging findings with CT has been performed first. Surgical lung biopsy remains needlessly invasive at this point.
Unenhanced thoracic CT was performed (Figure 4).
Figure 4. A-F: Representative images from thoracic CT in lung windows. G-I: Representative images in soft tissue windows. Lower panel: video of CT scan 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 fifth of seven pages)