Bilateral Lung Lesions Research Articles

A CASE REPORT OF PANCREATIC METASTASIS FROM PROSTATE CANCER.

We report a case of pancreatic metastasis from prostate cancer. A 65 year-old man developed gross hematuria, and was found to have a markedly elevated PSA and abnormal CT findings indicating mass lesions in bilateral lungs, and pancreatic head, and osteoblastic lesions in pelvic bone. He was referred to the department of Urology and Gastroenterology at Seirei Hamamatsu General Hospital. Digital rectal examination revealed a hen's egg-sized, stony-hard prostate. A systematic needle biopsy of the prostate demonstrated adenocarcinoma (Gleason score 4+4=8). We diagnosed multiple lung and bone metastases from prostate cancer, and suspected that a primary pancreatic ductal carcinoma. The patient was started on an androgen deprivation therapy (ADT) with bicalutamide and degarelix. After 4 months from the initiation of ADT, an MRI of the pancreas showed decreased size of the pancreatic head mass from 18 mm to 7 mm in diameter. We concluded that the pancreatic head mass was metastasis from prostate cancer, and currently continue ADT. Pancreatic metastasis from prostate cancer is very rare, and further accumulation of cases will be required.

PNEUMONIA IN PATIENTS WITH DRUG DEPENDENCE

The objective of this study was to investigate clinical course of septic pneumonia in patients with intravenous drug dependence. Methods. Routine clinical and radiological examination has been conducted in 55 consecutive pneumonia patients with intravenous narcotic dependence hospitalized in two hospitals at Barnaul city. A comparator group included 19 patients with septic pneumonia without drug abuse. Results. The majority of patients with intravenous drug dependence were younger than 40 years old ( p < 0.001), 42 (76.4 %) were men. HIV infection was detected in 20 patients (36.4 %). Opioid abuse was found in 11 patients, heroin abuse in 16 and desomorphine abuse in 28 patients; 51 patients were diagnosed with viral hepatitis (B, C, or both). In 61.8 % of patients with intravenous drug dependence, severity of pneumonia by CURB-65 score was ³ 3 compared to 2 in 68.4 % of comparative patients (c2 = 5.20, p = 0.044). The average SOFA score was 6.2 ± 1.8. The APACHE II score was > 25 in 29 patients (52.7 %). Severe sepsis (ACC / SCCM, 1992) more often diagnosed in patients with intravenous drug dependence ( n = 31; c2 = 5.10, p = 0.046). In the comparator group, sepsis was diagnosed in 11 patients (c2 = 3.19; p = 0.129). Septic shock was developed in 5 and 3 patients, respectively. Conclusion. In patients with intravenous drug dependence, pneumonia has more severe course with more frequent complications including tricuspid valve infective endocarditis, hepatic injury, bilateral and destructive lung lesions. Apart from adequate antimicrobial therapy, treatment of such patients should be targeted to improvement in microcirculation disorders.

Bedside chest radiography of novel influenza A (H7N9) virus infections and follow-up findings after short-time treatment

Background Influenza A (H7N9) virus infections were first observed in China in March 2013. This type virus can cause severe illness and deaths, the situation raises many urgent questions and global public health concerns. Our purpose was to investigate bedside chest radiography findings for patients with novel influenza A (H7N9) virus infections and the followup appearances after short-time treatment. Methods Eight hospitalized patients infected with the novel influenza A (H7N9) virus were included in our study. All of the patients underwent bedside chest radiography after admission, and all had follow-up bedside chest radiography during their first ten days, using AXIOM Aristos MX and/or AMX-IV portable X-ray units. The exposure dose was generally 90 kV and 5 mAs, and was slightly adjusted according to the weight of the patients. The initial radiography data were evaluated for radiological patterns (ground glass opacity, consolidation, and reticulation), distribution type (focal, multifocal, and diffuse), lung zones involved, and appearance at follow-up while the patients underwent therapy. Results All patients presented with bilateral multiple lung involvement. Two patients had bilateral diffuse lesions, three patients had unilateral diffuse lesions of the right lobe with multifocal lesions of the left lobe, and the remaining three had bilateral multifocal lung lesions. The lesions were present throughout bilateral lung zones in three patients, the whole right lung zone in three patients with additional involvement in the left middle and/or lower lung zone(s), both lower and middle lung zones in one patient, and the right middle and lower in combination with the left lower lung zones in one patient. The most common abnormal radiographic patterns were ground glass opacity (8/8), and consolidation (8/8). In three cases examined by CT we also found the pattern of reticulation in combination with CT images. Four patients had bilateral and four had unilateral pleural effusion. After a short period of treatment the pneumonia in one patient had significantly improved and three cases demonstrated disease progression. In four cases the severity of the pneumonia fluctuated. Conclusions In patients with influenza A (H7N9) virus infection, the distribution of the lung lesions are extensive, and the disease usually involves both lung zones. The most common imaging findings are a mixture of ground glass opacity and consolidation. Pleural effusion is common. Most cases have a poor short-time treatment response, and seem to have either rapid progressive radiographic deterioration or fluctuating radiographic changes. Chest radiography is helpful for evaluating patients with severe clinical symptoms and for follow-up evaluation.

Breathlessness With Pulmonary Metastases: A Multimodal Approach

Breathlessness With Pulmonary Metastases: A Multimodal Approach

Multitracer PET imaging of bone metastases from paraganglioma: peripheral halo of uptake on 18F-FLT PET mismatching with central uptake of 18F-FDOPA, 18F-fluorodopamine, and 18F-FDG

A 70-year-old man with a history of a right adrenal paraganglioma (24 cm) surgically removed 2 years before was referred for lower back pain, palpitations, and increased plasma catecholamine levels suspicious for recurrent paraganglioma. The patient underwent a multi-tracer PET imaging evaluation consisting of four different radiopharmaceuticals, each performed on different days in the same week: 18F-Fdopamine and 18F-FDOPA to specifically detect the presence of paraganglioma [1], 18F-FDG to assess glycolytic activity, and 18F-fluorothymidine (18F-FLT) to assess cell proliferation [2]. The scans revealed retroperitoneal masses, bilateral lung lesions, and bone lesions, with high and variable avidity for 18F-Fdopamine (A), 18F-FDOPA (B), and 18F-FDG (C). The inter-lesion and inter-tracer tracer avidity variability illustrates the metastatic metabolic heterogeneity. All lesions had low 18F-FLT uptake (D), suggesting a low rate of cellular proliferation. However, the bone lesions (green arrows) showed an interesting pattern on 18F-FLT PET. High 18F-FLT uptake is known to occur in normal bone, due to hematopoietic cells in the bone marrow compartment that are continually replacing circulating peripheral blood cells and are highly proliferative [3]. In this patient, bone lesions detected and delineated by T2-weighted MRI (E) and CT (F) showed low cellular proliferation, contrasting with their high catecholamine metabolism and high glycolytic activity. High non-specific peri-tumoral 18F-FLT uptake was seen (higher than the normal bone), most likely corresponding to the reactive proliferation of hematopoietic cells around the lesion. This should elicit caution when interpreting focal uptake (higher than the constitutively high bone marrow background uptake) of 18F-FLT in bone.

Plasma Heme Oxygenase-1 Levels Distinguish Latent or Successfully Treated Human Tuberculosis from Active Disease

BackgroundTuberculosis (TB) is associated with oxidative stress and the induction of host anti-oxidants to counteract this response. Heme oxygenase-1 (HO-1) is a critical promoter of cytoprotection in diverse disease models including mycobacterial infection. Nevertheless, the pattern of expression of HO-1 in human tuberculosis has not been studied. Here, we examine expression of HO-1 in M. tuberculosis-exposed and -infected individuals and test its ability to distinguish active from latent and successfully treated TB cases. In addition, we assess correlations between plasma levels of HO-1 and cytokines closely associated with the immunopathogenesis of TB.MethodsCross-sectional and longitudinal analyses of levels of HO-1, acute phase proteins and pro-inflammatory cytokines were performed in plasma samples from individuals with active pulmonary, extra-pulmonary or latent TB infection and healthy controls as part of a prospective cohort study in South India.ResultsSystemic levels of HO-1 were dramatically increased in individuals with active pulmonary and extra-pulmonary tuberculosis and particularly those with bilateral lung lesions and elevated bacillary loads in sputum. HO-1 levels effectively discriminated active from latent tuberculosis with higher predictive values than either C-reactive protein or serum amyloid protein. Moreover, there was a marked reduction in HO-1 levels in active TB cases following anti-tuberculous therapy but not in those who failed treatment. Pulmonary TB patients displaying the highest concentrations of HO-1 in plasma exhibited significantly elevated plasma levels of interleukin (IL)-10, interferon (IFN)-γ and IL-17 and diminished levels of tumor necrosis factor (TNF)-α.ConclusionThese findings establish HO-1 levels as a potentially useful parameter for distinguishing active from latent or treated pulmonary tuberculosis, that is superior in this respect to the measurement of other acute inflammatory proteins.

A Patient Presenting with Bilateral Lung Lesions, Pleural Effusion, and Proteinuria

Diagnosis and management of a systemic vasculitis are among the most demanding challenges in clinical medicine. A patient with a past history of cryptogenic organizing pneumonia presents with new bilateral lung lesions, unilateral pleural effusion, and significant proteinuria. The patient tested p-ANCA and anti-MPO positive but c-ANCA negative. A diagnosis of granulomatosis with polyangiitis GPA was reached after performing both renal and lung biopsies. Step-by-step differential diagnosis and management are discussed.

Atypical Pneumocystis jiroveci pneumonia with multiple nodular granulomas after rituximab for refractory nephrotic syndrome

Rituximab, an anti-CD20 antibody that targets B cells, is a promising agent against steroid-dependent and steroid-resistant nephrotic syndrome in children. We report a 3-year-old boy who presented with atypical Pneumocystis jiroveci pneumonia (PCP) following administration of rituximab for refractory nephrotic syndrome. He had received cyclosporine and daily prednisolone for over 1 year. Following rituximab therapy, a hazy shadow was observed on his chest X-ray. Chest-computed tomography revealed multiple nodular lesions in bilateral lungs, although his clinical symptoms were subtle. PCR analysis demonstrated the presence of Pneumocystis DNA in his bronchoalveolar lavage. Lung wedge resection of the nodular lesion exhibited granulomas containing a few cysts of P. jiroveci that primarily consisted of T cells and histiocytes and lacked B cells. A deficiency of B cells following rituximab treatment suggests a dramatic effect on the immune response and, therefore, could result in granulomatous PCP. Nodular granulomatous lesions of PCP comprise an emerging concept previously reported in adults with hematological disease, bone marrow transplant, or treatment with rituximab. We report the first pediatric case of nodular PCP. Granulomatous PCP can be life-threatening. Moreover, bronchoalveolar lavage often fails to demonstrate the presence of P. jiroveci DNA. Wedge biopsy is warranted for definitive diagnosis. Our patient fully recovered with sulfamethoxazole/trimethoprim treatment because of early detection. The indication of rituximab for refractory nephrotic syndrome has increased recently. Therefore, recognition of the risk of atypical PCP is important. Our findings suggest that PCP prophylaxis should be considered following rituximab therapy.

Rapidly Progressive Diffuse Cystic Lesions as a Radiological Hallmark of Lung Adenocarcinoma

CASE PRESENTATION A 39-year-old nonsmoking man presented to us with complaints of progressive hoarseness and nonproductive cough. Laboratory examinations revealed elevated serum carcino-embryonic antigen (15.49 ng/ml) and cancer antigen125 (40.01 U/ml). Chest computed tomography (CT) 1 month earlier showed a 25 20 mm central located mass in the left upper lobe and diffused cystic lesions in bilateral lungs (Figure 1). Repeated chest CT scan in our institution showed increased size of the mass at 35 30 mm and rapidly enlarged, widespread, disseminated thin-walled cystic lesions in bilateral lungs (Figure 2). Bronchoscopy revealed an endobronchial whitish lesion in the left apicoposterior segment bronchus but was otherwise normal. Histologic and immunohistochemical examination of the mass and blind-aspirated lung specimen established the diagnosis of adenocarcinoma. The cancer cells were poorly differentiated with a positive reaction to carcino-embryonic antigen, thyroid transcription factor 1, and cytokeratin 7 staining. Positron emission tomography revealed heterogeneous uptake of the mass, cystic lesion, and mediastinal lymph nodes, suggesting intrapulmonary metastasis. His clinical stage was T1N2M1 stage IV and epidermal growth factor receptor mutation test was negative. He underwent cisplatin/gemcitabine chemotherapy for four cycles. The next 3 months follow-up documented significant improvement and the patient was alive and stable. This report highlights that lung adenocarcinoma might present as multiple cystic lesions on rare occasions.1 It is essential to maintain a high index of suspicion for adenocarcinoma in patients with mediastinal mass and diffused thinwalled cystic lesions as observed in our case.

Multiple Pulmonary Metastases following Total Removal of a Bilateral Parasagittal Meningioma with Complete Occlusion of the Superior Sagittal Sinus: Report of a Case

Pulmonary metastases of benign meningiomas are extremely rare. The case of a 34-year-old man with bilateral parasagittal meningioma who developed pulmonary metastases is described. The meningioma was an enormous hypervascular tumor with invasion of the superior sagittal sinus. The tumor was resected completely and histologically diagnosed as transitional meningioma. The Ki-67 labeling index was 5%. Four months after operation, the patient subsequently developed bilateral multiple lung lesions later identified as metastases. The lung lesions were partially removed surgically and histologically diagnosed as meningothelial meningioma WHO grade I. The Ki-67 labeling index was 2%. The histological findings demonstrated that the tumor occupied the arterial lumen and the perivascular space, suggesting that pulmonary tumors might metastasize via the vascular route. The histopathological features and mechanisms of metastasizing meningiomas are reviewed and discussed.

Survival after resection of synchronous non–small cell lung cancer

Our objective was to determine the long-term survival of patients with resected synchronous multiple pulmonary malignant tumors. This is a multi-institutional retrospective study of patients who underwent surgical resection of synchronous (nonbronchioloalveolar) non-small cell lung cancer. Between March 1996 and December 2009, 67 patients (30 men) underwent 121 operations. Forty-four patients had bilateral tumors. Positron emission tomographic scans were performed in 58 (87%) patients, computed tomographic scans and magnetic resonance imaging of the brain in 53 (79%), and mediastinoscopy in 56 (84%). N2 lymph nodes were benign in all patients before undergoing resection of bilateral tumors of the same histologic type. Types of resection were lobectomy in 62, sublobar in 73, and pneumonectomy in 1. Eleven patients (16%) had postoperative morbidities. Cancer-specific 3- and 5-year survivals were 73% and 69%, respectively, and overall 3- and 5-year survivals were 64% and 53%, respectively. Subgroup analysis demonstrated no difference in overall survival at 5 years between bilateral tumors of the same histologic type (M1a) (49%) versus different histologic types 42% (P = .88), or between bilateral tumors (50%) and ipsilateral tumors (54%) (P = .83). The 5-year survival of surgically resected, synchronous, N2-negative, nonbronchioloalveolar, non-small cell lung cancer is excellent, even in patients who have bilateral lung lesions that harbor the same histologic features. Although the new TNM classification system labels this disease as clinical stage IV M1a, survival acts more like a separate T1 lesion after surgical resection. Thus, surgical resection should be considered in appropriately selected patients who have multiple pulmonary malignant tumors that are N2 negative.

Thyroid metastases from clear cell renal cell carcinoma: A case report.

e15066 Background: Renal cell carcinoma can metastasize to unusual sites such as the thyroid gland. Such cases typically present with a unilateral painless cold nodule at scintiscan, hypoechogenic at ultrasonography, with final diagnosis made by fine-needle aspiration. Methods: An 87-year-old woman with clear cell renal cell carcinoma was treated by radical nefrectomy in April 2003. She relapsed in 2009 in the abdomen and underwent resection of the large, symptomatic metastasis. Around the same time bilateral lung lesions appeared. The patient was subsequently treated with sunitinib 50 mg daily in cycles of 4 weeks with a two-week interval. The dose was reduced to 37.5 mg because of bone marrow toxicity. After 17 months of treatment the lung metastases were stable but bilateral thyroid nodules were detected. Results: Thyroid function tests were normal. Ultrasound-guided biopsy found atypical cell aggregates with clear cytoplasm and positivity for CD10 and vimentin, compatible with clear cell renal cell carcinoma. The patient began treatment with everolimus in January 2011. Conclusions: Although thyroid metastases from clear cell renal cell carcinoma are extremely rare and generally only appear, along with other extra-thyroid metastases, many years after the primary diagnosis, they must be taken into consideration in patients with a long history of renal carcinoma.

A case of neurosarcoidosis with swelling and gadolinium enhancement of spinal nerve roots on magnetic resonance imaging

An 80-year-old woman was admitted to our hospital because of developed sense of constriction in the trunk and gradually progressive numbness and muscle weakness in the upper and lower extremities. Cerebrospinal fluid analysis showed increased cell count and protein level. Gadolinium enhanced magnetic resonance imaging (MRI) of spine showed the enhancement and swelling of bilateral nerve root in the cervical and lumbar segments. Although chest computed tomography showed neither bilateral hilar lymphoadenopathy nor lung lesions and serum angiotensin converting enzyme and lysozyme (ACE) were normal, tuberculin skin test was negative and cell count and CD4/CD8 elevated in bronchoalveolar lavage fluid. Biopsy specimen of scalene lymph node showed noncaseating granuloma. The patient was treated with oral predonisolone, which improved her symptoms and abnormalities on MRI. It is important to consider neurosarcoidosis in the differential diagnosis of polyradiculopathy with swelling and gadolinium enhancement of spinal nerve roots.

Nine-Year Progression of Untreated Pulmonary Mycobacterium szulgai Infection

A 58-year-old man was seen with complaints of fevers, night sweats, weight loss, and multiple bilateral cavitary lung lesions. Mycobacterium szulgai with nearly identical antibiograms grew from separate sputum specimens 9 years apart. He was treated with a combination of clarithromycin and ethambutol with clinical, microbiologic, and radiographic resolution of disease. This is the longest untreated case of documented Mycobacterium szulgai infection reported, and offers a glimpse of its natural history when left untreated. Despite an infrequent isolation (<0.5% of cases), it is a pathogenic organism which warrants treatment.

Clinical analysis of invasive pulmonary fungal infections

To investigate the clinical characteristics of invasive pulmonary fungal infections (IPFI). The clinical data of 48 patients with confirmed IPFI at Peking Union Medical College Hospital from January 2004 to December 2008 were retrospectively analyzed. Patients were divided into primary IPFI group and secondary IPFI groups based on their disease courses. The most commonly seen fungi were aspergillus species (37.5%) and cryptococcus species (37.5%), and community acquired infections accounted for 87.5%. The secondary IPFI accounted for 66.7% among all cases, in which the major pathogens were aspergillus species; in the primary IPFI group, the major pathogens were cryptococcus species. The symptoms of IPFI were non-specific and mostly presented as cough, fever, hemoptysis, and dyspnea. The common imaging features included multiple nodules, infiltrates and consolidations, or diffused lesions in bilateral lungs, and cavities were found in 11 patients (22.9%). The clinical symptoms and imaging findings were not significantly different between these two groups. A total of 46 patients (95.8%) received antifungal therapies or surgeries. Ten patients (20.8%; all from the secondary IPFI group) died, making the fatality rate significantly different between the primary IPFI group and secondary IPFI group (P=0.033). The major pathogens of IPFI are aspergillus species and cryptococcus species, and most of them are community acquired. The secondary IPFI with aspergillus species tend to be highly fatal. The clinical symptoms and imaging features are non-specific. Early diagnosis with prompt antifungal therapies, or even with surgical intervention, may be beneficial for these patients.

Differential diagnosis problem of pulmonary changes in ulcerative colitis

Inflammatory intestinal diseases are often accompanied with extraintestinal and even pulmonary manifesStations. The treatment of these intestinal diseases includes sulphasalazine and mesalazine, which may have undesirable allergic and other side effects, including hypersensitive pneumonitis. Having performed colonoscopy due to abdominal pains and mushy stools, the diagnosis of ulcerous colitis was established in a 20-year-old female patient and the treatment with mesalazine initiated. However, the patient developed slimy and bloody stools, slightly increased body temperature, dry cough and bilateral lung lesions. The bronchological exploration established interstitial and organizing pneumonia. Despite the treatment with antibiotics, corticosteroids and mesalazine, dry cough, fever and bloody stools persisted, accompanied with bilateral inhomogeneous lesions of the pulmonary parenchyma. Upon discontinuation of the treatment with mesalazine, clinical symptoms and pulmonary lesions disappeared. The differential diagnosis of pulmonary lesions in patients with ulcerous colitis may be a problem. In the reported case, pulmonary lesions were interpreted as interstitial pneumonitis accompanying ulcerous colitis. However, they are most probably a consequence of allergic response to mesalazine.

Síndrome de Stewart-Treves: Caso clínico

Angiosarcomas are malignant tumors derived from the endothelium of blood vessel (hemangiosarcomas) or lymph vessels (lymphangiosarcomas). Lymph edema of the limbs is considered secondary when extrinsic injuries are observed and primary when these injuries are not present. Stewart-Treves syndrome or a Lymphangiosarcoma, developed over a chronic lymph edema, is a rare complication described in mastectomized patients but it can be observed in lymph edemas located elsewhere. It appears as nodular skin lesions that grow, multiply quickly and frequently metastasize. We report a 40-year-old mole with an angiosarcoma associated with primary chronic lower limb lymph edema. The patient consulted for a history of weight loss and malaise and appearance of violaceous lesions over the zone of lymph edema and inguinal lymph node involvement. A CT scan showed bilateral lung lesions and enlargement of inguinal and iliac lymph nodes. A biopsy of one of the skin lesions disclosed an angiosarcoma, diagnosis that was confirmed with immuno-histochemistry Chemotherapy was started but the patient died five months after the diagnosis.

Risk factors for early treatment failure in hospitalized patients with community-acquired pneumonia

Objective To determine risk factors associated with early treatment failure in hospitalized patients with community-acquired pneumonia ( CAP) . Methods Clinical data of 549 adult patients with CAP hospitalized at the No. 3 Hospital Affiliated to Sun Yat-Sen University, Guangzhou during January 2002 to January 2008 were analyzed retrospectively, and 68 of whom failed in early treatment Differences in baseline characteristics and clinical parameters including treatment and prognosis between those with and without early treatment failure were compared to identify relevant factors for early treatment failure with univariate and muitivariate logistic regression analysis. Results A total of 549 patients,including 341 elderly patients, were enrolled in the study, with a mean age of(61±23)years.Their mean length of hospital stay was 11 days, with 68 cases (12.4% ) in early treatment failure within 72 hours after admission and an in-hospital case-fatality of 10. 2 percent As compared to those of non-early treatment failure, aspiration pneumonia, concomitant neurological diseases, lesions in multilobar or bilateral lungs,hypotension (systolic blood pressure lower than 90 mm Hg) and inadequate antimicrobial therapy were more frequently seen in patients with early treatment failure. Results of muitivariate analysis indicated that risk factors independently associated with development of early treatment failure included aspiration pneumonia (95%CI= 2.752 - 17.553, P =0.011), multilobar or bilateral involvement of the lungs (95% CI =2. 043 -15. 241, P - 0. 020) and inadequate antimicrobial therapy ( 95% CI = 3. 478 - 18. 540, P =0. 001). Conclusions Early treatment failure associated with higher case-fatality rate and longer hospital stay for patients with CAP. Early detection and management of CAP require careful clinical assessment To decrease occurrence of early treatment failures, interventions need to be performed in advance to improve prognosis of patients with CAP. Key words: Community-acquired infection; Pneumonia; Treatment failure

Bilateral cystic pulmonary glial heterotopia and palatinal teratoma causing respiratory distress in an infant

We report on a male infant with extensive, bilateral cystic and solid lung lesions who presented postnatally with respiratory distress caused by bilateral cystic lung lesions. Parenchyma-sparing resections were performed. Histology revealed the presence of neuroglial cell-lined cysts and glial nodules. In addition, a neural element containing palatinal teratoma was detected and excised. Based on previously published cases, the pathogenesis and clinical features of pulmonary neuroglial heterotopia are discussed.

Inflammatory Myofibroblastic Tumor Presenting as a Large Mass and a Spontaneously Resolving Nodule in the Lung

A 21-year-old woman presented with nausea, vomiting, decrease in appetite, and weight loss of 6 months and right chest pain of 5 days' duration. Earlier diagnostic work-ups had been inconclusive, and she was referred for the evaluation of the bilateral lung lesions as seen on her chest x-ray. Thoracic computed tomography scan showed a 6-cm mass in the right lower lobe, a minimal right pleural effusion, and a peripheral 2-cm cavitary nodule in the inferior lingular segment. Ultrasonography-guided transthoracic cutting needle biopsy of the right-sided mass and following right lower lobectomy both yielded benign specimens pathologically assessed as "inflammatory myofibroblastic tumor." The chest x-ray and thoracic computed tomography scans obtained 1 month following the thoracotomy showed spontaneous and almost complete resolution of the left-sided nodule. In follow-up 1 year after the surgery, no clinical, laboratory, or radiologic recurrence was detected. She is being closely followed as an outpatient.