Correct!
1. Obtaining prior thoracic imaging studies for comparison to determine if the lung findings are new or stable over time
2. Enhanced thoracic CT
3. 1 or 2
Obtaining prior imaging studies is almost always the first priority when confronted with abnormal findings at chest radiography or thoracic CT. If one can show that abnormal findings are long-standing in nature, even if the etiology of the imaging abnormalities are uncertain, a conservative approach becomes possible, and the expense and potential for complications associated with more extensive evaluation may be avoided. Often, however, prior imaging studies have either not been performed or are unavailable, or, in some cases, the priors are not sufficiently old to assure that whatever imaging findings are present are innocuous. Furthermore, occasionally the patient’s presentation requires timeliness which may not allow management to be postponed while awaiting comparison to prior imaging studies. In such cases, typically thoracic CT is required for further investigation. Therefore, choice “1” is correct, but choice “2” is also reasonable, and thus the best answer is choice “3”- but “1” or “2" are also correct. Thoracic MRI is not suitable for the evaluation of lung parenchymal abnormalities in general, and is certainly not as established as thoracic CT for this purpose. Bilateral frontal shallow oblique images are useful for the evaluation of focal pulmonary parenchymal opacities detected at chest radiography, but a generally not of value for the evaluation of extensive interstitial abnormalities.
Frontal chest radiography (Figure 2) performed 4 years earlier was located for comparison.
Figure 2. Frontal chest radiography performed 4 years prior to presentation chest radiography (Figure 1).
Which of the following statements regarding this imaging study is most accurate? (Click on the correct answer to proceed to the next panel)