Correct!
4. Chest CT findings are suggestive of primary pulmonary neoplasia
The enhanced chest CT shows a right apical mass in close contact with the chest wall over the right lung apex. The lesion shows central low attenuation but no air bronchograms. Unlike fungal pneumonias, such as coccidioidomycosis, no surrounding satellite nodularity is present. No fat within the lesion is evident to suggest lipoid pneumonia as a possible etiology. The lesion could arise from the extraparenchymal soft tissues of the thorax, including the pleura (such as a solitary fibrous tumor of the pleura), intercostal neurovascular bundle (subclavian artery pseudoaneurysm and neurogenic lesion- see Figures 3B and C), or adjacent soft tissue or lymphoid tissue (see Figure 3D). However, the lesion in this circumstance appears centered in the apical lung parenchyma, as shown to advantage using multiplanar evaluation using sagittal and coronal planes (Figure 5) - these images show that the lesion makes relatively obtuse angles with the adjacent chest wall, rather than the more acute angles that would be expected for a lesion arising from an extraparenchymal location.
Figure 6. Sagittal (A and C) and coronal (B and D) enhanced chest CT images.
Based on the findings at enhanced chest CT, which of the following represents an appropriate next step for the evaluation of this patient? (Click on the correct answer to be directed to the seventh of 12 pages)