Correct!
5. More than one of the above
Decubitus chest radiography can prove useful to assess for pleural effusion (dependent side) or pneumothorax (non-dependent side), but chest ultrasound has already shown only trace pleural effusion on the left side, and thus decubitus chest radiography would probably provide no useful information. While enhanced pulmonary toilet is not a “wrong” answer as some secretions were noted at bronchoscopy, these secretions were not profound and the pattern of left lower lobe bronchial obstruction at bronchoscopy was not suggestive of a mucous plug. Other causes for left lower lobe bronchial obstruction should be considered and hence surgical consultation is advisable.
The patient underwent unenhanced chest CT (Figure 11).
Figure 11. Left: Axial unenhanced chest CT shows extensive left lung ground-glass opacity following left upper lobectomy associated with extensive left lung interlobular septal thickening (arrows). Dense central left lung consolidation is present associated with a truncated bronchus; the left lower lobe bronchus is not readily seen. A small anterior left upper chest pleural effusion (*) and post-operative hydropneumothorax (ยบ) are present. Right: video of thoracic CT in lung windows.
Which of the following represents the most accurate interpretation of this examination? (Click on the correct answer to be directed to the thirteenth of fourteen pages)