Correct!
1. Perform CT aortography
Surgical lung biopsy could be considered for the right lower lobe lesion, but the relatively indolent nature of this lesion, despite its recent apparent change, suggests a more conservative approach is in order. Bronchoscopy could also be considered, but the lesion is relatively peripheral and not clearly associated with an airway. If a tissue-sampling procedure is desired, percutaneous transthoracic fine needle aspiration biopsy would be the best approach for this lesion. However, the medial basal location and morphology raise the possibility of a particular diagnosis that could be readily evaluated with CT aortography. Of note, the CT protocol of most use in this situation is CT aortography, not CT pulmonary angiography- the latter technique would provide optimal contrast enhancement in reference to the pulmonary arteries, not the aorta and branch vessels, as is desirable in this circumstance.
After a week the patient underwent repeat CT (Figure 7), but not with CT aortography technique.
Figure 7. A-L: Axial enhanced thoracic CT displayed in soft tissue windows. M-P: Axial enhanced thoracic CT displayed 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 fourteenth of sixteen pages)