Correct!
Answer: 4. All of the above.
The apical opacities and calcified left mediastinal lymph node are unchanged in Figure 2 compared with Figure 1, representing stability for over 10 years. When interpreting chest radiography in the setting of suspected granulomatous infection, particularly for those patients with positive skin or blood testing for tuberculosis, a stable chest radiographic appearance for at least 4-6 months is required to conclude that active tuberculosis is unlikely. Note that patients with suspected tuberculosis showing a stable radiographic appearance, even for a long period of time, may occasionally have positive tuberculous cultures. Therefore, most workers suggest that patients suspected of tuberculosis showing abnormal but unchanged findings at chest radiography should be classified as “radiographically stable” rather than “disease-inactive.”
Although the cause of the apical opacities in this patient may be unknown, the lack of clear change in size for over 10 years is strongly suggestive of a non-malignant process.
Clinical Course: The patient underwent thoracic CT (Figures 3 and 4) for further investigation of the apical process.
Click here for Figure 3A. Movie of unenhanced thoracic CT shown in soft tissue windows.
Figure 3: Unenhanced thoracic CT shown in soft tissue windows (movie= A, representative still image axial image, B, and representative still image coronal image C), shows calcification within the biapical opacities. Calcified left hilar and subaortic lymph nodes are seen. Heavy coronary artery and great vessel calcification are present. Small right, and trace left, pleural effusions are present.
Click here for Figure 4a. Movie of unenhanced thoracic CT shown in lung windows.
Figure 4: Unenhanced thoracic CT shown in lung windows (movie= A, representative still image axial image, B) shows that the apical opacities are confluent and rounded, and are surrounded by ground-glass opacity nodules, some of which show a centrilobular distribution (arrows in B).
Which of the following best characterizes the thoracic CT findings?
