Correct!
4. 1 and 3

The chest radiograph shows several areas of what appears to be nodular consolidation (Figure 2). In addition, there is a right hilar fullness best visualized on the PA chest radiograph. There is no evidence of left lower lobe collapse which would be indicated by volume loss and a sail-like density often seen on the PA view behind the heart shadow.

Figure 2. Patient’s chest x-ray showing areas of nodular consolidation (arrows) and right hilar fullness.

A CT scan of the chest was performed to better define the abnormalities seen on chest x-ray (Figure 3).

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Figure 3. Selected thoracic CT lung window images (Panels A-E) and a soft tissue window through the right hilum (Panel F). A movie of the lung windows is shown on the lower left and of the soft tissue windows on the lower right.

Which of the following is the best next step in evaluating the patient?

  1. 18FFDG-PET scanning
  2. Bronchoscopy with bronchoalveolar lavage
  3. Careful observation with serial chest x-rays
  4. Needle biopsy of the lung
  5. VATS lung biopsy

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