Correct!
3. Repeat chest CT

Given the appearance of pneumonia on the chest radiograph and the previous history of lung carcinoma, and the patient’s lack of clinical response to presumably appropriate therapy, repeat chest CT is appropriate. Bronchoscopy could be considered as well, but may be better directed in light of information obtainable by chest CT. Given the suggestion that the chest radiographic abnormalities and the patient’s complaints reflect an acute lung disorder, both pulmonary function testing and 18FDG-PET scan are not appropriate tests at this point. As noted previously, thoracic MRI has a very limited role for the evaluation of pulmonary disorders, particularly acute lung abnormalities.

The patient underwent contrast-enhanced thoracic CT (Figure 6).

Figure 6. A-I (upper left): Axial enhanced thoracic CT displayed in soft tissue. J-P (upper right): Axial enhanced thoracic CT displayed in lung windows. Lower left: video of thoracic CT in soft tissue windows. Lower right: 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 be directed to the twelfth of sixteen pages)

1. Expected right middle lobectomy findings only
2. New mediastinal lymphadenopathy is present
3. The previously noted cystic medial right basal lesion has resolved
4. The previously noted cystic medial right basal lesion has significantly enlarged
5. The previously noted cystic medial right basal lesion now appears solid

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