Correct!
4. The nodules are indeterminate as regards their etiology and behavior, and any of the foregoing choices could be true

Any of the choices are potentially accurate. The nodules could be aggressive- metastatic disease is a common cause of nodules with the appearance seen in this case. However, post-infectious processes, particularly granulomatous infections, can manifest in this fashion also. Similarly, non-infectious inflammatory lesions, such as granulomatosis with polyangiitis (aka Wegener’s granulomatosi)] or rheumatoid nodules, may present in this fashion as well. The imaging findings are ultimately non-specific.

What is the appropriate next step for the evaluation/management of this patient?

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

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