Correct!
4. The 18FDG-PET shows hypermetabolism in the paramediastinal lesion and several of the enlarged mediastinal lymph nodes seen at thoracic CT

The 18FDG-PET scan is of good quality and readily interpretable. The study shows extensive hypermetabolism in the right paramediastinal mass as well as several, but not all, of the enlarged mediastinal lymph nodes seen at thoracic CT (Figure 5).

Figure 5. 18FDG-PET shows extensive hypermetabolism in the right paramediastinal mass (arrows, CF) as well as within several of the enlarged mediastinal lymph nodes (arrowheads, B and D) seen at thoracic CT (one right internal mammary lymph node- arrowhead in A- shows little metabolic activity.

These findings suggest the presence of malignancy, but are not specific; a number of infectious and non-infectious inflammatory lesions may show elevated glucose metabolism at 18FDG-PET scanning.

Given the contrast-enhanced thoracic CT and 18FDG-PET scan findings, which of the following is the next most appropriate step for obtaining a diagnosis in this patient? (Click on the correct answer to proceed to the next panel)

  1. Bronchoscopy with transbronchial biopsy and endobronchial ultrasound
  2. Mini-thoracotomy
  3. Percutaneous transthoracic fine needle aspiration and core biopsy
  4. Thoracoscopic surgical lung biopsy
  5. Any of the above

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