Correct!
3. Obtain thoracic CT
Treating with antibiotics and performing follow up imaging is a reasonable approach when a bacterial infection is suspected, and, occasionally, bacterial infections can appear somewhat rounded- so-called “round pneumonia.” This process tends to be encountered more commonly in children. The appearance of the opacities at chest radiography in an adult asymptomatic patient would be highly unusual for a bacterial infection. Performing 18FDG-PET scan is not unreasonable, but typically 18FDG-PET scans are most informative following morphologic characterization of pulmonary, pleural, or mediastinal abnormalities with thoracic CT. Surgical lung biopsy is inappropriately aggressive at this point, and bronchoscopy is premature, as the opacities at chest radiography should first be confirmed and characterized more thoroughly before invasive procedures are considered.
The patient underwent thoracic CT (Figure 2) for further characterization of the opacities detected at chest radiography.
Figure 2. Panels M-T: Axial enhanced thoracic CT displayed 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 fourth of ten pages)