Correct!
5. The thoracic CT shows that the right thoracic lesion seen at chest radiography is solid and enhancing
The lesion first seen at chest radiography is enhancing- note the attenuation of the lesion prior to contrast administration (Figure 5A-C) compared with the images following contrast administration (Figure 5D-F) - a clear attenuation increase is present. The lesion is solid, showing soft tissue attenuation; no low attenuation within the lesion to suggest cystic change or necrosis is present. The lesion clearly resides within the mediastinum, at least in part- note the close contact with the right lateral wall of the trachea and obliteration of the fat usually present in this area. However, the lateral aspect of the lesion shows features suggesting some extension into lung- note how the lesion approaches and contacts right upper lobe segmental vasculature (see Figure 5D). The lesion therefore is closely related to the right mediastinal pleura as well. The lesion does not enhance to the same degree of mediastinal arteries or veins, nor is any connection to such structures present.
The patient then underwent 18FDG-PET scanning (Figure 6), which showed significant hypermetabolism within the lesion.
Figure 6. Axial 18FDG-PET images show that the right thoracic lesion is hypermetabolic (compare activity within the lesion to mediastinal blood pool activity).
What is the appropriate next step for the evaluation / management of this patient? (Click on the correct answer to move to next panel)