Correct!
4. Conservative management
Given the patient’s young age and absence of apparent co-morbidity or complicating factors, conservative management with clinical follow-up is appropriate. 18FDG-PET scanning is premature at this point, and the results of 18FDG-PET are unlikely to alter the approach to the patient’s management. Furthermore, typically, results from 18FDG-PET scanning are interpreted in the context of the imaging findings at chest CT and the latter has yet to be performed. Invasive diagnostic testing is also premature at this point, and the patient’s presenting complaints are not suggestive of acute pulmonary embolism, nor were risk factors for such identified. No features to suggest cardiac disease are present in the patient’s history, physical examination, laboratory data, or at chest radiography to suggest a need for cardiac MRI.
The patient’s chest radiograph was interpreted as normal. He was discharged from the emergency room with a prescription for broad-spectrum antibiotics. Subsequently he returned to the Emergency Room 3 days later with complaints similar to his initial presentation. Repeat laboratory data showed slight elevation in the white blood cell count, now abnormal at 12.4 x 109 / L (normal, 4-10.8 x 109 / L). Repeat chest radiography (Figure 2) was performed.
Figure 2. Frontal (A) and lateral (B) chest radiography at re-presentation.
Which of the following statements regarding the repeat chest radiograph is most accurate? (Click on the correct answer to be directed to the fourth of fourteen pages)