An 85 year-old man was seen in consultation for an abnormal chest radiographic finding. His medical history was remarkable for hypertension, glaucoma, and lifelong dysarthria due to cerebral palsy. In recent years, signs of early dementia had developed, and he had to use a walker because of an unsteady gait. A chest radiograph after a recent fall showed an abnormality, which prompted the consultation.
At the time of evaluation, he complained of dyspnea on exertion and intermittent nonexertional retrosternal chest pain of 6-months duration. He denied cough, fever, hemoptysis, or weight loss. On review of systems, he complained of dyspepsia and long-standing constipation. His medications included an antihypertensive, timolol eye drops, calcium carbonate for dyspepsia, and psyllium for constipation. He had quit smoking cigarettes 56 years ago.