Lung Masses in a 70-Year-Old Man<xref rid="AFF1"><sup>*</sup></xref>

Abstract

(CHEST 2005; 127:1433–1436) A 70-year-old man presented with progressive mild dyspnea on exertion, cough, and low-grade fevers. He had a long history of atrial fibrillation, recurrent despite multiple cardioversions, and antiarrhythmics, and was currently rate controlled with amiodarone, 200 mg po tid. He also had a history of coronary artery disease documented by coronary angiography, asthma, and prior transurethral resection of prostate for benign prostatic hyperplasia. He was a lifelong nonsmoker with no occupational exposures. Physical examination revealed an elderly man in no acute distress. Heart rate was 82 beats/min, BP was 150/80 mm Hg, respiratory rate was 16 breaths/ min, and temperature was 37.1°C. Auscultation of the chest revealed mildly diminished breath sounds with otherwise normal lungs. The remainder of the physical examination was normal. Laboratory data were unremarkable, with a normal CBC, serum chemistry and liver function test results, and erythrocyte sedimentation rate. The chest radiograph (not shown) demonstrated a hazy mass at the peripheral aspect of the right lung base. The cardiac size was normal. CT scan of the thorax revealed subcarinal lymph node enlargement (Fig 1) and masses in the left upper, left lower, right lower, and right middle lobes (Fig 2), each approximately 1 cm in size. There was focal ground-glass opacity in the azygoesophageal recess (Fig 3). At bronchoscopy, there was no evidence of endobronchial lesions. Bronchial washings were negative for acid-fast bacilli and fungi, with rare atypical keratinizing squamous cells.