An 18-year-old female presents after completing her freshman year at college. Two months ago, she developed "bronchitis" which has persisted. She has become increasingly tired and has frequent night sweats. A chest x-ray today reveals a left mediastinal mass. What is the next step in her evaluation?
- repeat the chest x-ray in six months
- ultrasound of the left hemithorax
- bone scan
- CT scan of the chest
- proceed directly to bronchoscopy with biopsy
CT scan of the chest
Any patient presenting with mediastinal nodes should have a CT. This patient may have sarcoid or Hodgkin's or another type of cancer - CT is indicated.