Correct!
5. The bilateral, frontal, shallow (5°) oblique radiographs show that the nodule “does not move” with the ribs, confirming a lung origin for the nodule

The image on the left (Figure 1B) is a “right anterior oblique image- note how the right clavicle is projected across midline, indicating that the patient’s right chest has moved anteriorly. The other image (Figure 1C) is a left anterior oblique image- note how the patient’s left clavicle crosses midline, indicating that the left chest has moved anteriorly. The nodule is visible in both projections; therefore it is not artifactual, and image quality is technically adequate. Note that on Figure 1A, the nodule projects between the 3rd and 4th anterior ribs, whereas on Figure 1B and 1C the nodule projects directly over the 4th anterior rib and then partially overlies the third anterior rib, respectively. The nodule also shows an inconsistent relationship to the posterior ribs. Because of this inconstant relationship to the ribs, the nodule must not originate from the chest wall, and instead resides within the lung. No evidence of a tubular morphology to suggest arteriovenous malformation is present.

Because the oblique chest radiographs confirmed the presence of an indeterminate lung nodule, thoracic CT (Figure 3) was performed.

Figure 3. Thoracic CT displayed in lung windows (D- L) and soft tissue windows (M-U).

Which of the following statements regarding this CT examination is most accurate? (Click on the correct answer to proceed to the next panel)

1. The thoracic CT shows a diffuse fibrotic process
2. The thoracic CT shows multifocal basal predominant bronchiectasis
3. The thoracic CT shows that the nodule at chest radiography is non-calcified and remains indeterminate
4. The thoracic CT shows that the nodule contains fat, consistent with hamartoma
5. The thoracic CT shows that the nodule is partially calcified but also reveals a left mainstem bronchial lesion

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