Case 32--Lung Mass in an Elderly Smoker

Clinical summary: A 76-year-old, Chinese, male smoker presented in 7/99 with a LLL lung mass clinically suspicious for cancer. He had no cough, chest pain, or fever. Positron emission tomography (PET scan) showed low-grade positivity of the mass (suggesting a low-grade tumor or inflammation), bilateral hilar uptake, and an abnormal left adrenal gland (low standard uptake value of 1.8). Bronchoscopic and mediastinoscopic biopsies were negative for tumor and granuloma. FNA of the lung mass showed cells consistent with non-necrotizing granuloma, but stains and cultures for fungi and acid fast organisms were negative, and he reported that his PPD was negative in 8/98. Three sputum smears and cultures for tuberculosis were negative. He appeared well. His heart rate was 92/min, BP 120/70 mmHg, respiratory rate 16/min, and O2 saturation on air 94%. Physical examination showed no abnormalities. Breath sounds were good, and wheezes and rales were absent. On 10/5, he underwent excision of the superior segment of the LLL, which contained a 3 x 4 cm mass.

Radiology | Image 1 | Image 2 | Image 3 | Discussion

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