A 74-year-old woman presented with a 2-year history of worsening dyspnea and nonproductive cough that were aggravated by lying down. Three months prior, she had community-acquired pneumonia, which was treated successfully with antibiotics on an outpatient basis. During that time, she reported a few episodes of blood-tinged sputum that resolved after 2 days. She denied weight loss, loss of appetite, chest pains, fevers, chills, or night sweats. She had no symptoms suggestive of gastroesophageal reflux disease or postnasal drip syndrome. Her past medical history was significant for paroxysmal atrial tachycardia that was well controlled with metoprolol. Review of her family history indicated that her mother died of colon cancer, her father died of bladder cancer, and she had a brother with bone cancer. She is married and a retired registered nurse with a 30-pack-year history of tobacco use that she quit 40 years ago.