02-20-2008, 10:09 AM
A 45-year-old man comes to the emergency department with a 2-hour history of chest pain. He is admitted to the hospital for evaluation of an acute coronary syndrome and ruled out for a myocardial infarction. As part of his workup a chest x-ray is obtained, which reveals a 2.5-cm mediastinal mass seen on the anterior-posterior chest x-ray in the left upper lobe. The lesion is felt to be extrapulmonary and forms an angle with the pleura. The patient denies fever, chills, or hemoptysis. He does have a smoking history of three packs a day for the last 16 years. He has no other medical history. He takes no medications. His vital signs are stable, lungs are clear, and laboratory studies are normal. Which of the following is the most appropriate next diagnostic step?
A. Bronchoscopy
B. CT scan of the chest
C. Lung biopsy
D. MRI of the chest
E. Mediastinoscopy
A. Bronchoscopy
B. CT scan of the chest
C. Lung biopsy
D. MRI of the chest
E. Mediastinoscopy