Correct!
3. A posterior mediastinal mass
Figure 1: Frontal chest radiograph shows somewhat hyperlucent-appearing lungs, suggesting obstructive lung disease. A smoothly marginated contour is present in the right paraspinous area (arrows), projecting through the right heart and mediastinum.
Clinical Course
The patient returned 4 years later for follow up imaging (Figure 2A and B).
Figures 2A and B: Frontal (A) and lateral (B) chest radiographs obtained 4 years after Figure 1 show enlargement of the right paraspinous contour abnormality. The lateral radiograph (B) shows faintly increased opacity overlying the mid- to lower thoracic spine, suggesting that the lesion is located in the posterior mediastinum.
The main abnormal finding on the earlier chest radiograph was thought to have become more pronounced, so thoracic CT (Figure 3A and B) was performed. What is the main finding on the thoracic CT?
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Figure 3: Axial (A) and coronal (B) thoracic CT displayed in soft tissue windows shows bilateral, right-larger-than-left, paraspinous masses. The coronal image (B) highlights the paraspinal location of the lesions. The paraspinous masses contain visible areas of low attenuation, consistent with fat. Compare the appearance of these low attenuation areas with that of subcutaneous fat.
Among the following choices, which is the next most appropriate step in the evaluation of this patient?
