Correct!
2. Bronchoscopy
Given that an abnormal focus has been shown in the right basal bronchial trunk, direct examination of the airway to evaluate this endobronchial abnormality is warranted. 18FDG-PET scanning is not particularly useful here because the absence of tracer utilization would not allow bronchoscopy to be deferred, whereas the presence of increased tracer utilization would not distinguish between inflammatory and neoplastic etiologies for the endobronchial lesion. Video-assisted thoracoscopic lung biopsy is not an appropriate procedure for evaluating central airway lesions, nor is pleuroscopy. Similarly, dynamic contrast-enhanced MRI would not be useful for evaluation of an endobronchial lesion contributing to focal bronchiectasis; this seldom used procedure has been employed for solitary pulmonary nodule characterization.
The patient underwent bronchoscopy and an endobronchial lesion was identified (Figure 4).
Figure 4. Bronchoscopic image showing an endobronchial lesion lodged in the right basal bronchial trunk.
The endobronchial lesion seen at this study could not be readily grasped. Probing the lesion did not reveal bleeding, but the lesion was not readily moveable, and there was concern that, given the wedged nature of the focus, attempts at retrieval may drive the lesion more distally or result in airway injury.
Which of the following represents the next most appropriate step for the evaluation of this patient? (Click on the correct answer to proceed to the seventh of eight pages)