A 39-year-old woman presented with dry cough, which she had had for 3 months. She had mild intermittent asthma and a 5 pack-year smoking history. Her symptoms started after an upper respiratory tract infection and persisted despite multiple courses of antibiotics, decongestants, and corticosteroids.
The patient experienced episodes of pleuritic chest pain, shortness of breath with exertion, and generalized malaise. This was accompanied by low-grade fevers and night sweats. She reported losing 10 lb during this time. She denied recent history of any sick contacts or travel and had no known exposure to allergens or toxic fumes, but she had had a pet dog and a turtle for many years. Her mother had died of lung cancer at 39 years of age.
Her physical examination findings were remarkable for crackles in the left upper zone. Complete blood cell count revealed leukocytosis (leukocyte count, 20,500/[micro]L), anemia (hemoglobin level, 8.5 g/dL), and thrombocytosis (platelet count, 608,000/[micro]L), and her erythrocyte sedimentation rate was elevated. HIV and purified protein derivative test results were negative, and the sputum specimen was negative for acid-fast bacilli.
The patient's chest radiograph (Figure 1) and CT scan of the chest (Figure 2) are shown. What is the likely diagnosis?
The patient's chest radiograph showed a large left suprahilar mass with cavitation (Figure 1). This was confirmed by a CT scan that showed a large area of consolidation, with an air bronchogram in the left upper lobe and an air-fluid level in the lateral part of the consolidation (Figure 2).
An underlying malignancy was suspected on the basis of...