A 54-year-old woman is evaluated after a 1.5-cm nodule was detected in the right lower lobe of the lung on a chest radiograph done to evaluate new-onset dyspnea on exertion. The nodule was not present on a chest radiograph done 8 years ago. The patient lives in Missouri and has not traveled recently. She has a 30-pack-year history of cigarette smoking but quit smoking 3 years ago. Her medical history includes hypertension and hyperlipidemia, and her medications are hydrochlorothiazide and atorvastatin. There is no family history of lung cancer. On physical examination, the temperature is 36.8 °C (98.0 °F), the blood pressure is 124/72 mm Hg, the pulse rate is 64/min, and the respiration rate is 14/min. The lungs are clear, the skin is normal, and there is no lymphadenopathy. Pulmonary function testing shows mild airway obstruction and no acute response to a bronchodilator. Contrast-enhanced CT scan of the chest shows the nodule to be uncalcified on thin-section images, and there was no significant enhancement (10 Hounsfield units) on dynamic contrast study. Histoplasma serology is negative. Which of the following is the most appropriate management for this patient? A - Bronchoscopy and biopsy of the lesion B - CT-guided transthoracic biopsy of the lesion C - Repeat CT scan in 3 months D - Video-assisted thoracoscopic surgery to remove the nodule E - No further evaluation
Posted on: Sun, 21 Sep 2014 18:10:48 +0000
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