Correct!
2. Contrast-enhanced thoracic CT
Repeat frontal chest radiography is not likely to be beneficial as the abnormality detected at presentation chest radiography is unlikely to be artefactual and the chest radiographic abnormalities are substantial and merit immediate investigation. Pulmonary function testing could prove useful for physiologic assessment, but it is unlikely that pulmonary function testing would provide information that would provide an explanation for the marked abnormalities seen at chest radiography. Video-assisted thoracoscopic surgical lung biopsy certainly could provide a diagnosis, but invasive diagnostic procedures are premature at this point- further non-invasive techniques could yield important information that may change the diagnostic approach. 18FDG-PET scanning could also prove useful for further investigation, but generally this examination delivers a higher radiation exposure than thoracic CT, and the demonstration of metabolic activity, or the lack thereof, would not preclude the need for further investigation of the patient’s clinical complaints and chest radiographic findings. In general, 18FDG-PET scanning is more rewarding when the need for the examination is more clearly defined through previous non-invasive imaging examinations and clarification of the clinical context. Thoracic CT, preferably performed with intravenous iodinated contrast, would be the most useful procedure to provide information regarding the etiology of the chest radiographic findings.
The patient underwent enhanced CT of the thorax (Figure 2).
Figure 2. Upper panel: Static representative images from axial enhanced thoracic CT displayed in soft tissue (A-F) and lung (G-L) windows. Lower left: video of enhanced thoracic CT scan in soft tissue windows. Lower right: video of thoracic CT in lung windows.
Which of the following is correct regarding the description of the thoracic CT findings? (Click on the correct answer to proceed to the fourth of seven pages)