(CHEST 2005; 128:1018–1021) A 73-year-old woman presents to her physician complaining of a nonproductive nagging cough. Her medical history is remarkable for breast cancer treated by mastectomy 25 years prior to hospital admission and left lower extremity melanoma treated by excision 15 years prior to admission. She has a history of type II diabetes, a history of asthma that began around the age of 12 years, hypothyroidism, and a history of childhood acne treated with radiation therapy. She also has a 10 pack-year history of smoking, having stopped 43 years ago. Her surgical history is notable for a tonsillectomy, adenoidectomy, nasal polyps, dilatation and curettage, hysterectomy, and thyroidectomy. At presentation, the patient is receiving levothryoxine, conjugated estrogen, and latanoprost eye drops. She reports multiple allergies to medications, including iodinated contrast, erythromycin, codeine, tetracycline, nitrofurantoin, aspirin, atropine, and bacitracin. Physicial examination shows a well-nourished woman breathing comfortably on room air. Her pulse is 81 beats/min, respiratory rate is 18 breaths/min, and BP is 112/54 mm Hg. Her neck is supple to palpation without evidence for cervical or supraclavicular lymphadenopathy. Her oropharynx is within normal limits. Her chest is clear to auscultation without evidence for wheezing or crackles. Her cardiac examination is within normal limits. A chest radiograph (Fig 1) demonstrates a focal, oblong, 4-cm mass in the right middle lobe. Chest CT (Fig 2) shows that this mass is of slight increased attenuation compared to the skeletal muscle. No adenopathy is noted. The patient undergoes bronchoscopy, which demonstrates no evidence for an endobronchial lesion in the central or segmental airways. Whole-body positron emission tomography (PET) is then performed and shows intermediate uptake in the majority of the mass with a small focus of markedly increased 18-fluorodeoxyglucose (FDG) uptake within the center of the lesion (Fig 3). There is intermediate uptake in the right hilum on the PET scan. The patient is subsequently referred for a right middle lobe lobectomy.