Correct!
5. Serial imaging evaluation of the nodule to exclude growth
68Ga – PET – CT dotatate scanning is typically used for neuroendocrine malignancies, and, while peripheral large cell neuroendocrine malignancies and small cell malignancies do occur, they are uncommon and 68Ga – PET – CT dotatate scanning would be used in this context only after a diagnosis has been established. Pleuroscopy would not be of value for this patient as no pleural abnormality is present. Both thoracoscopic and transthoracic percutaneous biopsies could establish a definitive diagnosis for this patient, but the presence of calcification as well as the lack of tracer utilization at 18FDG-PET scanning predict that this nodule is benign; therefore, serial evaluation for nodule growth, rather than obtaining an invasive tissue diagnosis, may be the management strategy favored by the available data.
The patient underwent serial clinical and imaging evaluation assessment. Coccidioidomycosis serologies were negative. Pulmonary function testing showed nonspecific proportionate reductions in forced vital capacity and forced expiratory volume in 1 second, with carbon dioxide diffusion capacity 73% predicted. Resting and exercising blood oxygenation was normal. The patient underwent bronchoscopy, and biopsy showed a “rare” granuloma in the normal-sized right paratracheal lymph node but was otherwise non-diagnostic. The patient was schedule for repeat unenhanced thoracic CT, performed 6 months later (Figure 5).
Figure 5. A-D: Representative images in lung windows from the repeat thoracic CT scan performed 6 months after the initial CT scan. Lower panel: video of thorcic 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 ninth of ten pages)