Philadelphia VA Medical Center, Philadelphia, PA
Correspondence to: Mitchell L. Margolis, MD, FCCP, Pulmonary Section, Philadelphia VA Medical Center, Philadelphia, PA 19104; e-mail: email@example.com
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.
Become a CHEST member and receive a FREE subscription as a benefit of membership.
Individuals can purchase this article on ScienceDirect.
Individuals can purchase a subscription to the journal.
Individuals can purchase a subscription to the journal or buy individual articles.
Learn more about membership or Purchase a Full Subscription.
Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited:
Customize your page view by dragging & repositioning the boxes below.
Enter your username and email address. We'll send you a reminder to the email address on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.