Correct!
3. Conservative therapy with imaging follow-up
Enhanced thoracic MRI is unlikely to provide any useful information regarding the pulmonary abnormalities detected at thoracic CT. 68Ga-dotatate scanning is used for the detection and assessment of treatment response for neuroendocrine malignancies, but the nature of the pulmonary abnormalities is not suggestive of malignancy. 18F-fluciclovine is used for the detection of prostate carcinoma and therefore is not relevant to this patient. The pulmonary abnormalities, as well as the patient’s presentation, are not suggestive of thromboembolic disease and therefore CT pulmonary angiography would probably not contribute significant information to what is already known from the previous two chest CTs. Given that the volume of pulmonary disease overall has decreased on the repeat chest CT, and the patient feels well, a conservative approach appears reasonable.
The patient presented to her pulmonary physician about 26 days later, about 146 days after her initial presentation, again complaining of fatigue, body aches, and occasional chills of 10 days duration. Her repeat complete blood count now showed a mildly elevated white blood cell count of 11.9 x 109 / L (normal, 3.4 – 9.6 x 109 / L with mild eosinophilia of 0.87 x 109 / L (normal, 0.03 – 0.48 x 109 / L) and her C-reactive protein level remained elevated as well at 75 mg/L (normal, ≤8 mg/L). She denied cough, mucous production, or chest pain. Repeat chest radiography (Figure 5) was performed.
Figure 5. Repeat frontal chest radiography.
Regarding the chest radiograph, which of the following statements is most accurate? (Click on the correct answer to be directed to the eighth of twelve pages)