Case 1:

A 55 year old male with no significant past medical history presents for evaluation of an abnormal chest x-ray which was obtained as part of a work-related physical. The patient reports no symptoms of dyspnea, cough, hemoptysis, chest pain, or wheezing. He also denies any prior lung disease, weight loss, night sweats, or palpable lymph nodes or masses. He is married, with 3 adult children, drinks socially, has smoked around 1 ppd for 30 years, and works as a business executive without known occupational exposures. There is no significant past medical history, he is on no medications, and his review of systems is non-contributory.

His perspective of illness is “I’m scared to death that this ‘shadow’ might be cancer and I want to get it taken care of immediately.”

Physical exam was notable for the absence of any palpable lymphadenopathy, hepatosplenomegaly, or clubbing as well as a completely normal pulmonary examination.

Chest x-ray revealed a 1.5 cm nodule in the left upper lobe without any evidence of volume loss, increased interstitial markings, pleural effusions, lymphadenopathy, or other nodules/abnormalities.