Correct!
2. Comparison to prior imaging if available
As a general rule with practically any imaging finding (note that there are always exceptions), comparison to prior studies is the first step when evaluating abnormal imaging findings. If an abnormality can be shown to be completely stable for a number of years, often such demonstration can change management from the need for immediate tissue sampling to a conservative strategy of observation, with associated reduction in cost, morbidity, and, rarely, even mortality. Among the choices list, bronchoscopy with transbronchial biopsy is also a reasonable choice, and would be the preferred management strategy should no prior imaging be available. The remaining choices listed are rather invasive for a first-line investigation.
Prior imaging performed 8 years earlier (Figure 6) was located for comparison.
Figure 6: Upper panels: Representative images comparing the presentation thoracic CT (Figure 1, labeled “Current”) and the previous thoracic CT performed nearly 8 years earlier (labeled “8 Years Earlier”). Lower panel: video of thoracic CT performed 8 years ealier in lung windows.
Which of the following represents the most accurate assessment of the comparison between the lung imaging findings on the presentation thoracic CT (Figure 1) and the comparison thoracic CT performed 8 years earlier (Figure 6)? (Click on the correct answer to be directed to the fourth of nine pages)