Correct!
4. Check for infections, such as coccidioidomycosis
The chest radiograph is clearly abnormal and may subsequently lead to further investigations, including invasive tissue sampling procedures, but these approaches are premature at this point. 18FDG-PET scanning is also premature at this point, and the results of 18FDG-PET are unlikely to alter the approach to the chest radiographic findings. Typically, results from 18FDG-PET scanning are interpreted in the context of the imaging findings at chest CT and the latter has yet to be performed. Cardiac MRI is not relevant for this patient, at least at this point, as neither her history nor her chest radiograph suggests cardiac dysfunction.
Investigations for fungal infections, including Aspergillus and Coccioides, were unrevealing; Coccioides IgM and IgG enzyme immunoassays, Coccioides complement fixation, and immunodiffusion were negative. The patient was referred to pulmonary medicine, and her pulmonary physician did elicit a history of a new-onset dry cough, but no chest pain, shortness of breath, night sweats, or arthralgias. By the time of her pulmonary medicine appointment, her rash had resolved and the muscle aches were improving. The patient underwent chest CT (Figure 2).
Figure 2. Left: Axial enhanced chest CT displayed in lung (A-H) and soft tissue (J-L) windows. Center: Video of chest in lung windows. Right: Video of chest CT in soft tissue windows.
Which of the following statements regarding the chest CT is most accurate? (Click on the correct answer to be directed to the fourth of twelve pages)