Correct!
5. Thoracic CT
Bronchoscopy may play a role in the evaluation of this patient, given that bronchial obstruction remains as a potential etiology for the patient’s now unexplained extensive left-sided thoracic volume loss, but this procedure is premature at this point. Thoracic CT would be capable of non-invasively assessing for right-sided thoracic space-occupying lesions that may produce contralateral mediational shift as well as the various potential etiologies capable of producing extensive left-sided volume loss, such as left mainstem endobronchial obstruction, left-sided visceral pleural restriction, and left lung agenesis / aplasia. 133 Xe-Ventilation – 99m Tc-perfusion scintigraphy could provide some information regarding abnormal ventilation and differential pulmonary perfusion, but it is unlikely that this procedure would allow a confident determination of the cause of the extensive left-sided thoracic volume loss. 168 Ga-citrate scanning is now seldom used, only occasionally playing a role for the assessment of diffuse lung disease, which is not relevant to this patient. 18FDG-PET scanning is primarily employed for the assessment and staging of primary intrathoracic malignancy and metastatic disease as well as the evaluation of an indeterminate solitary pulmonary nodule, but would not be of value for this patient at this point in his evaluation.
Figure 2. A-F: Representative images form axial unenhanced thoracic CT displayed in lung (A-E) and soft tissue (F-I) windows.Center video: unenhanced axial CT in lung windows. Right video: unenhanced axial CT in soft tissue windows.
Figure 3. Left A-C: Representative images from coronal unenhanced thoracic CT displayed in lung windows.Right: video of coronal unenhanced CT in lung windows.
Which of the following statements regarding this imaging study is most accurate? (Click on the correct answer to proceed to the seventh of nine pages)