Correct!
6. All the above
Computed tomography (CT) of the chest shows extensive airspace consolidation in multiple segments of the right lower lobe with adjacent nodular groundglass opacification (Figure 2).
Figure 2. Representative images from thoracic CT in lung windows (A) and soft tissue windows (B).
Position emission tomography (PET) of the full body was obtained six weeks later (Figure 3).
Figure 3. Representative images from the position emission tomography (PET) of the full body with transverse views through the chest (A,B) and coronal view of the whole body (C).
PET demonstrates interval complete collapse of the right mainstem bronchus and right lung with diffuse fluorodeoxyglucose (FDG) uptake throughout the right lower lobe with FDG activity extending into the right middle and lower lobes. PET also shows FDG-avid supraclavicular and mediastinal lymphadenopathy and numerous FDG-avid osseous lesions throughout the axial and proximal appendicular skeleton.
Right hemithorax video-assisted thorascopic surgery (VATS) was performed. Pleural studding was identified on both the parietal and visceral pleural surfaces with visible neoplastic implants on the surface of the right lower lobe (Figure 4).
Figure 4. Images from VATS showing pleural studding.
Bronchoscopy performed soon after VATS showed circumferential narrowing of the right mainstem bronchus and complete occlusion of the sub-segmental airways of the right upper lobe and bronchus intermedius by both endobronchial tumor and external compression (Figure 5).
Figure 5. Images from bronchoscopy showing narrowing of the right mainstem bronchus.
What is your leading diagnosis at this time? (Click on the correct answer to be directed to the fourth of five pages)