Question

if multiple pulmonary masses are seen on a chest x - ray, what must be ruled out first? pulmonary metastasis pneumoconiosis tuberculosis sarcoidosis

Explanation:

When multiple pulmonary masses are seen on a chest X - ray, pulmonary metastasis (spread of cancer to the lungs from another primary site) is a very common and serious consideration. Metastatic lesions are frequently multiple in the lungs. Pneumoconiosis (lung disease due to inhalation of dust) usually has a more specific occupational history and different radiographic patterns related to the type of dust. Tuberculosis can have various manifestations but is not the most immediately concerning in terms of "must be ruled out first" when multiple masses are present in a general sense (though it is important in certain populations). Sarcoidosis often has a more characteristic pattern of bilateral hilar adenopathy along with pulmonary infiltrates rather than just multiple masses in the way that metastases can present.

Answer:

Pulmonary metastasis