Correct!
3. The thoracic CT shows a mixed attenuation, hyper- and hypoattenuating left thoracic mass

The lesion in the left lower thorax shows a combination of increased attenuation with linear-shaped, very regular-appearing, decreased attenuation (hyper-and hypoattenuating, respectively) centrally, but the areas of decreased attenuation do not show fat density; rather, they appear to show air or gas density. No hilar or mediastinal lymph node enlargement is evident. Whether or not the lesion is vascular cannot be ascertained on this unenhanced study, although a clear relationship to Intrathoracic vessels is not evident. The left lower thoracic mass does not show a clear relationship to left lower lobe airways. Furthermore, other features that suggest an endobronchial origin for the lesion, such as post-obstructive atelectasis, air-trapping, or pneumonitis, or mucus impacted bronchi, are not present.

What is the appropriate next step for the evaluation / management of this patient?

  1. Bronchoscopy with transbronchial biopsy
  2. Serial thoracic CT to assess for growth
  3. 18FFDG-PET scanning
  4. Percutaneous transthoracic fine needle aspiration biopsy
  5. Open surgical lung biopsy
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