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Postgraduate Education Corner: CASE RECORDS OF THE UNIVERSITY OF COLORADO |

A 59-Year-Old Man With Chronic Cough

Darren M. Boé, MD, PhD; Steve D. Groshong, MD, PhD; Michael Canham, MD
Author and Funding Information

*From the Division of Pulmonary Sciences and Critical Care Medicine (Dr. Boé), University of Colorado Health Sciences Center; and Division of Pulmonary Sciences and Critical Care Medicine (Drs. Groshong and Canham), National Jewish Medical and Research Center, Denver, CO.

Correspondence to: Darren M. Boé, MD, PhD, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Health Sciences Center, 4200 E Ninth Ave, C272, Denver, CO 80262; e-mail: Darren.boe@uchsc.edu


The authors have no personal or financial conflicts of interest related to the preparation and publication of this manuscript.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).


Chest. 2008;134(4):876. doi:10.1378/chest.08-0352
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Extract

Eighteen months ago, a 59-year-old man was seen in our clinic for a chronic cough of 5 years in duration. He was initially seen at an outside facility 5 years prior, at which time he was treated with the cessation of captopril taken for hypertension. He was also thought to have bronchitis and was treated with antibiotics without benefit. A CT scan at that time revealed atelectasis in the lingula, and bronchoscopy demonstrated an endobronchial mass in the distal left mainstem bronchus extending into the left upper lobe with occlusion of the airway to the lingula. The biopsy revealed severe acute and chronic inflammation and atypical squamous metaplasia, for which he underwent a left upper lobectomy. The operative findings revealed atelectatic lingula, purulent material from the orifice of the lingula, and “heaped-up” friable and erythematous mucosa at the orifice. The hilar lymph nodes were described as “sticky, thickened, and scarred with dense reactive nodal tissue.” Special stains for organisms were negative, and culture findings revealed no bacterial, fungal, or mycobacterial growth. His cough continued postoperatively, and trials of bronchodilators, corticosteroids, and antireflux measures with proton-pump inhibitors resulted in no significant or lasting response.

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