Correct!
3. Comparison to prior thoracic imaging studies
As a general rule, whenever chest imaging studies show an abnormality, if comparison images are available, they should be reviewed. When such comparison studies show stable findings, a less aggressive posture regarding the evaluation of the imaging abnormalities is often warranted, and, on occasion, imaging abnormalities may be entirely dismissed as benign when long-term stability is demonstrated. In this patient’s case, it is unlikely that the multiple nodules detected at chest imaging will be simply dismissed through comparison to prior studies, but the approach to the current imaging findings may be altered by the results of such comparison studies. Thoracic CT would be a reasonable option to pursue while prior studies are being located, but thoracic CT was not offered as one of the choices for the question. Rather, serial thoracic CT assessment for nodule growth was offered as a choice, but, based on the size and number of the nodules, this management strategy is not the best choice. Tissue sampling procedures are reasonable considerations as well, but premature at this point. Finally, 18FDG-PET may prove of use for the evaluation of this patient at some point, but the results of 18FDG-PET are unlikely to alter the approach to the chest radiographic findings- if the nodules are metabolically active, they will likely be characterized by thoracic CT, and the same will occur if little metabolic activity is seen within these nodules. Furthermore, in the setting of nodule assessment, 18FDG-PET scanning is typically reserved for patients in whom the nodules are found to be indeterminate and non-specific following thoracic CT characterization.
A frontal chest radiograph from 3 years earlier (Figure 2) was located for comparison.
Figure 2. Frontal chest radiograph performed 3 years earlier.
Which of the following statements regarding the chest radiograph is most accurate? (click on the correct answer to be directed to the fourth of 11 pages)