Correct!
3. Obtain thoracic CT
The results of the ultrasound procedure suggest that the right pleural space process is complex and multiloculated, and it is likely further intervention will be required. Thoracic CT is the optimal method for further non-invasive investigation of the right pleural space process. Repeating the chest radiograph is not an “incorrect” maneuver, given that radiography is often performed after a pleural space intervention to exclude a complication such as pneumothorax. However, such a complication is very unlikely given the large right pleural space abnormality and minimal amount of fluid removed. Furthermore, thoracic CT will be quite capable of excluding post-procedural pneumothorax while simultaneously providing additional information regarding the right pleural space process. Similar to upright frontal chest radiography, decubitus chest radiography will not provide additional useful information at this point in the patient’s course. Bronchoscopy with bronchoalveolar lavage is again not the procedure of choice at this point. Thoracic MRI could provide information regarding the pleural space process similar, but not superior to, thoracic CT, and typically costs more and takes longer to perform than thoracic CT, and is incapable of providing information equivalent to thoracic CT regarding the status of the lung parenchyma.
Thoracic CT (Figure 4) was performed.
Figure 4. Panels A-D: Representative thoracic CT lung windows. Panels E-H: Corresponding soft tissue windows. Lower left: Movie of the CT lung windows. Lower right: Movie of the CT soft tissue windows.
Which of the following statements regarding these CT examinations is most accurate? (Click on the correct answer to move to the next panel)