Correct!
4. Perform unenhanced chest CT
Unenhanced chest CT is typically the next test performed when an indeterminate solitary pulmonary nodule is encountered at chest radiography. As noted above, 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. Follow up chest radiography to assess for stability may be an appropriate approach when a lesion is considered low risk for malignancy. This patient’s relatively young age (43-years-old) may favor a benign etiology, but the size (2 cm), ill-defined nature of the lesion, and the lack of clear visualization of calcification within the nodule render the lesion indeterminate in nature, and no clinical or laboratory tests suggest that an infectious granuloma may be cause of this lesion. 18FDG-fibroblastic activation protein inhibitor (FAPI) scanning utilizes peptidomimetic quinolone derivatives that bind to fibroblastic activation protein expressed on cancer-associated fibroblasts in tumor stroma, whereas 18FDG-PET exposes malignancy through detection of glycolytic activity in neoplasms. Initial testing has shown that 18FDG-FAPI may accurately detect a number of different malignancies, but is not in widespread use for the evaluation of an indeterminate solitary pulmonary nodule. 18FDG-prostatespecific membrane antigen [PMSA] has been utilized for the detection of prostate carcinoma, which is not a consideration for this patient.
The patient underwent enhanced chest CT (Figure 3).
Figure 3. Left: Axial enhanced chest CT displayed in lung (A-E) and soft tissue (F-I) windows shows a spiculated apical nodule with a pleural tail. The lesion contains a small focus of calcium (arrowheads). Right: Video of chest CT in lung windows.
Which of the following statements regarding the chest CT is most accurate? (Click on the correct answer to be directed to the eighth of thirteen pages)