A 49-year-old, white man with a 100–pack-year smoking history presented with progressive scapular paresthesias and pain radiating down his right arm for 6 weeks. His medical history was significant for low-grade transitional cell bladder cancer status post transurethral bladder resection. He had multiple chemical exposures as a military aviator. He presented to another institution, where a CT chest scan demonstrated a 4.5 × 2.5-cm right apical lobulated and necrotic mass, bilateral hilar and subcarinal adenopathy, and tree-in-bud interstitial markings (Fig 1). He underwent fiberoptic bronchoscopy (FOB) with transbronchial biopsy (TBBx) of the right upper lobe (RUL) and transbronchial needle aspiration (TBNA) of a subcarinal lymph node. The TBBx demonstrated noncaseating granulomas, and subcarinal biopsy specimens showed lymphoid tissue without malignancy. He then presented to our institution for evaluation of increasing back and right arm pain. Physical examination was normal except for point tenderness over the suprascapular region of the right upper back with no palpable adenopathy.