Correct!
2. Autoimmune serology panel
Bronchoscopy would probably be unrewarding given the lack of a clear suspicious pulmonary abnormality, although could be considered given the reticulation present as well as the thoracic surgeon’s impression of the presence of a right lower lobe nodular abnormality. 18FDG – PET scan could be considered, given some features that raise concern for undiagnosed malignancy- the intraoperative right lower lobe abnormality, the intraoperative frozen section findings suspicious for malignancy and the inability of the formal surgical biopsies to definitively exclude such, and the lack of clear explanation otherwise for the pleural effusion. Such an approach could potentially disclose an unsuspected focus that could be targeted for biopsy, but such an approach is frequently low-yield and expensive. Enhanced chest MRI can be used for pleural assessment but is unlikely to provide information in addition to that already known after two chest CTs. An autoimmune serology panel may be of benefit as pleuritis can be an intrathoracic manifestation of connective tissue disease, particularly rheumatoid arthritis.
Autoimmune serologies were obtained and the patient underwent chest CT (Figure 8).
Figure 8. Left A-D: Unenhanced chest CT performed more than one month following thoracoscopic surgery and pleural biopsy. Right: Video of unenhanced chest CT.
Which of the following represents an appropriate interpretation for this examination? (Click on the correct answer to be directed to the fifteenth of seventeen pages)