Puzzler #1:
A 65-year-old woman who smokes comes to see you regarding abnormal chest radiograph findings demonstrating a small nodule. The radiograph had been obtained in an ED where she had presented with atypical chest pain that resolved with ibuprofen. She has had a persistent cough for about 3 months but pursues a very active lifestyle. There is no dyspnea. She has smoked one pack of cigarettes daily since 1961. Her doctor has prescribed tiotropium inhaler therapy.
You order a CT scan, and the results are shown in Figure 1. Based on the findings, you perform a flexible bronchoscopy. An endobronchial lesion is seen in the left mainstem bronchus. The cytologic findings from endobronchial brushings are shown in Figure 2.
Case Puzzlers are a brief clinical vignette on various educational topics. Developed by members of the American College of Chest Physicians' NetWorks, it provides you an opportunity to sharpen your skills.
