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Postgraduate Education Corner: PULMONARY AND CRITICAL CARE PEARLS |

A 49-Year-Old Man With Concurrent Diagnoses of Lung Cancer, Sarcoidosis, and Multiple Regions of Adenopathy on Positron Emission Tomography

Matthew McNeill, MD, CPT, MC USA; Thomas B. Zanders, DO, MAJ, MC USA; Michael J. Morris, MD, FCCP, COL, MC USA
Author and Funding Information

*From Internal Medicine Residency (Dr. McNeill) and Pulmonary Disease Service (Drs. Zanders and Morris), Department of Medicine, Brooke Army Medical Center, Ft. Sam Houston, TX.

Correspondence to: Matthew McNeill, MD, CPT, MC USA, Brooke Army Medical Center, 3851 Roger Brooke Dr, Ft. Sam Houston, TX 78234-6200; e-mail: matthew.mcneill@amedd.army.mil


The authors have no financial support or conflicts of interest to disclose.

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


Chest. 2009;135(2):546-549. doi:10.1378/chest.08-1221
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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.

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