Correct!
1. 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. Further evaluation with cross sectional imaging or 18FDG-PET may occasionally be averted with this approach, the latter typically employed after a nodule at chest radiography has been evaluated with chest CT and found to be indeterminate. In this case, 18FDG-PET may not be required if the nodule is shown to be stable for a long period of time. Similarly, chest CT may also be avoided if prior chest radiographs show long-term nodule stability. Furthermore, nodule evaluation with CT is typically performed without use of intravenous contrast, unless a specific pulmonary nodule enhancement protocol is used. Lateral decubitus chest radiography is employed to further characterize pleural effusion [mobile vs. loculated or pleural thickening] or for the detection of pneumothorax, and hence does not pay a role for the evaluation of this patient.
A chest radiograph performed just over one year earlier, prior to the patient’s urologic surgery, was located for comparison (Figure 1B).
Given this comparison, which of the following represents the least likely consideration for the patient’s presentation chest radiographic findings? (Click on the correct answer to be directed to the fourth of fourteen pages)