A lung cancer masquerader

Abstract

A 58-year-old man presented with 3 months history of hemoptysis. He denied having fever, night sweats, chest pain, shortness of breath, orthopnea, loss of appetite or unintentional weight loss. He had 60 pack-year history of smoking, quit 5 years ago. He did not drink alcohol and never used illicit drugs. He worked as a welder for 30 years and reported no history of sick contacts or travel abroad. His past history was remarkable for hypertension, chronic obstructive pulmonary disease. He had right upper lobectomy 5 years ago for suspicious pulmonary nodule in an outside facility. He was informed that his nodule was related to his occupational exposure. His medications which adequately controlled his pulmonary symptoms were inhaled tiotropium and albuterol. On physical examination, his vital signs revealed a temperature of 37.1°C, BP of 135/81 mmHg, heart rate of 85/min, respiratory rate of 16/min and O2 saturation of 97% on room air. He appeared comfortable and not in acute respiratory distress. Chest examination showed scar of previous right-sided thoracotomy, otherwise, no additional breath sounds. There was no clubbing or cyanosis. The remainder of the examination was unremarkable. Laboratory tests showed WBC 5.6 × 109/l, hemoglobin 13.0 g/dl and pletlets 180 × 109/l. INR 1.19 and PTT 25.6 s. His basic biochemical profile and urine analysis were normal. The chest radiograph (CXR) showed a 1.5 cm multiform density nodular shadow in the right upper zone (Figure 1). A computed tomographic scan (CT) showed a 1.5 cm solitary nodular shadow in the superior segment of right lower lobe with no hilar or mediastinal lymphadenopathy (Figure 2). The 18F-fluorodeoxyglucose and positron emission tomography (FDG-PET) scan showed a focal area of increased uptake (standard uptake values—SUV—of up to 3.8) at the site of the right …