Correct!
3. Comparison to prior chest radiography
Whenever a lesion is discovered at chest imaging, comparison to older chest imaging studies is of paramount importance. If a chest lesion can be shown to be stable for a significant length of time, the evaluation of a chest lesion may be tempered, saving expense, potential radiation exposure, patient anxiety, and possibly even complications. For this patient, if the right upper lobe lesion were shown to be unchanged for several years, rather than pursuing a potential malignancy evaluation, the lesion may be followed with imaging. Chest MRI plays little role in the evolution of a solitary pulmonary nodule. While pulmonary opacities can be visualized at chest MRI, and MRI has the advantage of the lack of ionizing radiation, evaluation of the pulmonary parenchyma is generally more rewarding using CT. Lateral decubitus chest radiography is potentially useful for evaluating pleural effusions (typically to determine if pleural fluid is mobile or flowing, or for the detection of pneumothorax), but does not play a role for the evaluation of a solitary pulmonary nodule. 18FDG-PET scan may be an appropriate test for this patient, but is generally performed in patients with solitary pulmonary nodules following chest CT showing indeterminate findings.
The patient had never undergone previous chest imaging. Coccidioidomycosis and Quantiferon testing were negative.
Which of the following represents an appropriate next step for the patient’s management? (Click on the correct answer to be directed to the seventh of thirteen pages)