4. The chest radiograph shows multiple, bilateral circumscribed nodules

The chest radiograph shows multiple, bilateral circumscribed nodules, but the nodules do not contain internal lucency- there is no evidence of cavitation. The interstitium does not appear abnormally thickened and lung volumes appear normal. The circumscribed nature of the opacities, and the lack of air bronchograms, indicate that the chest radiographic abnormalities should not be characterized as consolidation. The hilar and mediastinal contours appear normal- no evidence of peribronchial or mediastinal lymphadenopathy is seen.

Which of the following courses of action is the most appropriate next step for the management of this patient? (click on the correct answer to be directed to the third of 11 pages)

  1. 18FDG-PET scanning
  2. Bronchoscopy with transbronchial biopsy
  3. Comparison to prior thoracic imaging studies
  4. Percutaneous transthoracic fine needle aspiration biopsy
  5. Serial thoracic CT to assess for growth or change in the size of the nodules