A 60-year-old man with a past history of smoking for 30 years (he stopped 3 years ago, prior to cardiac bypass surgery) is admitted with cough and mild hemoptysis. He is afebrile with no shoness on breath. Physical exam is negative except that the lung exam reveals rhonchi in the left upper lung zone. The finding/abnormality most likely to occur with the lesion seen on the CXR in
A large, 7 x 11-cm mass is seen in the left parahilar area. This has a well-defined edge and silhouettes out the hilar structures. The diaphragms are flattened, and there is no pleural disease. There are mediastinal (sternal) wires from prior CABG. This CXR is consistent with a bronchogenic carcinoma and is likely to be associated with hypercalcemia if this is small cell or squamous cell carcinoma. The clinical findings are not consistent with fungal disease or thromboembolism. The chest x-ray in fungal infection is usually multi-segmental, and pulmonary embolism tends to cause patchy infiltrates with pleural effusion. Koilonychia is spoon-shaped nails seen in severe iron-deficiency anemia.
Serum calcium of 13.6 mg/dL
Sputum positive for fungal elements
Increased D-dimer levels
Koilonychia
Respiratory system