Correct!
3. Comparison to prior thoracic imaging studies
Among the choices listed, comparison to prior studies is typically the first approach when abnormalities are detected at chest radiography. Indeed, as a general rule, whenever chest imaging studies show an abnormality, if comparison images are available, they should be reviewed. When such comparison studies show stable findings, a less aggressive posture regarding the evaluation of the imaging abnormalities may be possible, and, occasionally, imaging abnormalities may be entirely dismissed as benign when long-term stability is demonstrated. Thoracic CT would clearly be an appropriate choice for further evaluation of this patient’s chest radiographic abnormalities, but thoracic CT was not offered as one of the choices for the question. Thoracic MRI was offered as one choice to the answer to this question, but thoracic MRI is not the best answer because the abnormalities at chest radiography appear to reside within the lung, and thoracic MRI is not the best modality for evaluation of the lung parenchyma. 18FDG-PET scanning is premature that this point, and the results of 18FDG-PET are unlikely to alter the approach to the chest radiographic findings given the size and morphology of the opacities seen at chest radiography- if the nodules are metabolically active, they will likely be characterized by thoracic CT, and the same will occur if little metabolic activity is seen within these nodules. Furthermore, 18FDG-PET scanning for nodule assessment is typically employed for patients in whom the nodules are found to be indeterminate and morphologically non-specific following thoracic CT characterization. Finally, tissue sampling procedures- both bronchoscopy with transbronchial biopsy and percutaneous transthoracic needle biopsy- are premature at this point.
The patient underwent brain MRI for the evaluation of his headaches, which showed multifocal sinus opacification, but no abnormalities of the brain parenchyma or meninges were seen. A frontal chest radiograph from 4 years earlier (not shown) was located for comparison, which showed that the nodules seen at presentation chest radiography (Figure 1) were unchanged in both size and morphology.
Regarding the presentation chest radiograph (Figure 1), which of the following statements is most accurate? (Click on the correct answer to be directed to the fourth of ten pages)