Challenge for Diagnosis and Staging: Case Discussion 2

A 73-year-old woman presents with persistent cough and weight loss. She describes thecough as productive of yellow sputum for as long as she can remember, but recently she has notedoccasional streaks of blood in her sputum. Her appetite has been poor recently and has had anunintentional weight loss of 7 Kg over the past 4months. Her past medical history includes chronicobstructive pulmonary disease (COPD), diabetes,HTN, and CHF. She endorses a 50 pack-yearsmoking history and she does not describe anyoccupational exposures. Her primary care physicianorders a chest x-ray that reveals a right-sided lungnodule. A follow-up CT scan of the chest shows aright-lower lobe, spiculated lung nodule along withenlarged subcarinal and station 11 L lymph nodes. The patient’s primary care provider is concernedthat the speculated nodule is malignant. A whole body PET scan is performed with shows the rightsidednodule and the subcarinal lymph node to be FDG-avid with only mild FDG-avidity of the 11L lymph node.