For a patient with an isolated coin lesion on chest x-ray, what is the next appropriate step in evaluation?

In cases where a patient presents with an isolated coin lesion on a chest x-ray, the initial step should focus on determining the nature of the lesion, which typically involves obtaining more detailed imaging. Reviewing old radiographs can help identify any changes over time, but this step is not the most immediate or appropriate action for evaluation.

The next best step in the evaluation of a new coin lesion is to obtain a chest CT scan. A chest CT provides better characterization of the lesion than a standard x-ray, allowing for assessment of size, contour, calcification patterns, and associated structures, which can help differentiate between benign and malignant processes.

While scheduling a lung biopsy or preparing for surgical resection might eventually be part of the management plan depending on the findings, these steps are usually considered after imaging and further evaluation have been conducted. Comprehensive imaging is essential before deciding on invasive procedures. Therefore, for an isolated coin lesion, the appropriate next step is to proceed with a chest CT for a thorough evaluation.