Correct!
5. More than one of the above
Whenever an abnormality is discovered at chest radiography, determining the chronicity of the finding through comparison to prior chest examinations is of paramount importance, particularly in the case of pulmonary nodules, focal pulmonary opacities, and diffuse lung disorders. Lateral decubitus chest radiography is most commonly employed to evaluate for pneumothorax, by examining the non-dependent lung for the characteristic visceral pleural line, or freely mobile pleural effusion through examination of the dependent hemithorax. However, lateral decubitus chest radiography would be of little benefit for the focal lung opacity on this patient’s chest radiograph. 18FDG-PET scan is useful for the assessment of focal pulmonary abnormalities, particularly nodules, but neither positive nor negative results for the opacity detected at chest radiography in this patient would be management-altering because the opacity is relatively non-specific and could be the result of neoplasm, infection, or numerous other possibilities. Whenever focal lung opacities are detected at chest radiography in adult patients, follow up imaging to demonstrate interval resolution is wise, as pulmonary neoplasm may present as nonspecific focal opacities, but will be detected by persistence at follow up. Therefore, both comparison to prior chest radiographs and follow up chest radiography are correct answers.
Testing for coccidioidomycosis was indeterminate for IgM and negative for IgG. The patient underwent nerve blocks for her headaches over the next few months. She was treated as an outpatient for presumed bronchitis with azithromycin after she had presented to an outside emergency room with complaints of cough. Repeat chest radiography (Figure 3) performed 6 weeks after the initial chest radiograph (Figure 1) was performed.
Figure 3. Frontal (A) and lateral (B) chest radiography performed 3 months following the patient’s diagnosis of COVID-19 (Figure 1).
Which of the following represents the most appropriate interpretation for the patient’s imaging findings? (Click on the correct answer to be directed to the fifth of 11 pages)