A 65-year-old Chinese woman was referred for evaluation of pulmonary and pleural nodules found on a chest x-ray when she initially presented with pneumonia. A subsequent computed tomography (CT) scan of the chest revealed a peripheral 2 x 3–cm lung mass in the superior segment of the left lower lobe (Fig 1A), a 1 x 2–cm lingular nodule, and a 1 x 2.5–cm left-sided nodular pleural thickening (Fig 2A).
These corresponded to sites of marked uptake on positron emission tomography scan (Figs 1B and 2B). There were also other areas of thickening in the anterior and posterior chest walls. Her past medical history was remarkable for ductal carcinoma-in-situ of the right breast, which was treated with lumpectomy and radiation 3 years before this presentation without evidence of recurrence.
She also had hypothyroidism and hypercholesterolemia, which were well controlled. She immigrated at the age of 10 years from Canton, China, to the United States and denied tobacco use, regular alcohol use, or any known toxin exposures. She described a dry, nonproductive cough and occasional dysphagia. Her physical examination and routine laboratory results were unremarkable.