Correct!
1. Perform unenhanced chest CT
Unenhanced chest CT is typically the diagnostic study of choice when a new indeterminate nodule is encountered in an adult patient. As noted previously, lateral decubitus chest radiography is reserved for assessment of layering pleural effusion [with the affected side dependent] or pneumothorax [with the affected side non-dependent]. PET scanning with 68Ga-Dotatate is typically used for the evaluation of neuroendocrine malignancies, and could play a role for this patient if that diagnosis is subsequently confirmed, but is as yet premature. Thoracic MR is not commonly employed for the assessment of new pulmonary nodules; chest CT is generally more rewarding for that application).
The patient underwent unenhanced chest CT (Figure 3).
Figure 3: Axial (A-D) and sagittal (F) unenhanced chest CT displayed in lung (A-D, F) and soft tissue (E) windows shows a non-calcified mildly lobulated 16 mm left upper lobe nodule in contact with the left superior mediastinum (arrow, C), accounting for the chest radiographic abnormality. The patient has undergone previous right mastectomy with associated right apical reticulation representing previous radiation therapy. Lung parenchymal attenuation is heterogeneous. A video of the chest CT in lung windows is shown on the right.
Which of the following represents an appropriate interpretation for this examination? (Click on the correct answer to be directed to the sixth of nine pages).