A 71-year-old man presents with complaints of headaches and weakness that have been ongoing for almost a month. He denies any fever, nausea, or vomiting. He has noticed an occasional cough and denies any weight loss.
The patient has an extensive history of coronary artery disease, hypertension, and hyperlipidemia. History is also significant for coronary artery bypass grafting. He denies any history of smoking.
The man is afebrile, and the rest of his vital signs, including pulse oximetry, are within normal limits. Physical exam shows an elderly, ill-appearing man in no obvious distress. Breath sounds bilaterally are clear.
You order a chest radiograph along with some bloodwork. The chest radiograph is shown. What is your impression?
ANSWER
The chest radiograph demonstrates evidence of previous sternotomy. No evidence of acute infiltrate is noted.
However, there is a prominence within the left hilar region. This finding is strongly suggestive of neoplasm until proven otherwise. The patient was promptly referred for CT of the chest, abdomen, and pelvis, which confirmed the lesion. Subsequent CT-guided biopsy was performed.
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