Correct!
2. Obtain prior chest radiographs or thoracic imaging for comparison
In most situations, when an indeterminate lung nodule is encountered at chest radiography, it is most rewarding to obtain prior chest imaging to determine if the nodule is stable. While short-term stability has relatively little meaning as regards the possibility of malignancy, demonstrating long-term stability, particularly greater than two years, is a strong predictor of a benign etiology for a lung nodule. Thoracic CT is a reasonable choice as well, but typically thoracic CT characterization of nodules is conducted using unenhanced technique. On occasion, intravenous contrast may be injected for solitary pulmonary nodule characterization using a specialized protocol. 18FDG-PET scanning is also useful for charactering solitary pulmonary nodules but is typically obtained after any prior imaging is obtained and reviewed and the nodule has been characterized with unenhanced thoracic CT. Focal solitary pulmonary nodules are rarely the result of active bacterial pulmonary infection; therefore, presumptive treatment with broad-spectrum antibiotics and repeating imaging within 2 weeks is unlikely to be a rewarding management approach.
No prior thoracic imaging was available for comparison.
Which of the following represents the most appropriate management step for the evaluation of this patient? (Click on the correct answer to proceed to the fourth of ten pages)