Philadelphia VA Medical Center, Philadelphia, PA
Correspondence to: Mitchell L. Margolis, MD, FCCP, Pulmonary Section, Philadelphia VA Medical Center, Philadelphia, PA 19104; e-mail: firstname.lastname@example.org
To the Editor:
I offer the following addendum to the article by Kelly et al
A 49-year-old male smoker developed cough and dyspnea. Physical
examination disclosed clubbing and a prominent localized wheeze over
the right anterior chest and trachea. Chest roentgenograms and CT
showed a large right upper lobe mass with encroachment into the right
upper lobe bronchus and trachea. The patient was sent for pulmonary
function tests (PFTs) to assess the pulmonary reserve prior to
bronchoscopy and possible lung resection.
During the initial spirogram, encouraged by the usual
exhortations and encouragement to “blow it all out!,” the patient
expectorated a huge (9 cm), cylindrical, slimy wedge of gray and tan
tissue, which flopped onto the floor amid 10 to 15 mL of bright red
blood and copious mucus. The size of the specimen was such that the
pulmonary function technician initially feared the patient had somehow
severed his tongue. The tissue was gingerly placed in a plastic bag and
transported to the pathology department. The “gross” specimen was
found to comprise fragments of squamous cell carcinoma with large areas
of necrosis and fibrous tissue. The patient remained singularly
unperturbed by the incident and was spared further diagnostic
Although I do not recommend this method for diagnosing lung cancer on
account of its rarity and lack of aesthetic value, it does illustrate
unexpected and definitive diagnostic utility for PFTs.
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