Correct!
1. Flexible fiberoptic bronchoscopy
Repeat flexible fiberoptic bronchoscopy is certainly a reasonable consideration for this patient at this point, but it may be prudent to first repeat the thoracic CT to determine if the lung opacities have worsened. It is possible that the CT could provide diagnostically useful information or, absent such, the CT could at least direct further procedures for tissue diagnosis. Thoracic MR is generally not rewarding for the study of diffuse pulmonary disease, particularly when a prior CT is available for comparison and the primary intent of repeat imaging is to assess for changes from the prior CT. Thoracentesis is not indicated given the absence of pleural effusion. Mediastinoscopy is generally reserved for patients with accessible mediastinal lymph node enlargement or masses, neither of which are present in this patient.
Unenhanced thoracic CT (Figure 4) was performed.
Figure 4. A-F: Representative images from the axial thoracic CT displayed in lung windows, performed 2 months after Figure 2 and 5 months after initial presentation. Right: video of axial thoracic 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 eighth of nine pages)