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.