A 71-year-old woman, with a history of non-small cell lung cancer (NSCLC) with subsequent pneumonectomy presented with worsening dyspnea on exertion and non-productive cough.

The patient first noted the shortness of breath and cough 4 weeks prior to presentation, which were refractory to albuterol nebulization. The patient also reported a 6 lb. weight loss duringthis time period. She denied fevers, chills, night sweats or chestpain. The patient was diagnosed with NSCLC 11 years ago andunderwent a right-sided extrapleural pneumonectomy at that time. She received no radiation or chemotherapy. She did not require home oxygen and reported a generally good functional status prior to the development of her latest symptoms. Other past medical history included hyperlipidemia. The patient had been smoking a pack of cigarettes per day for the past 35 years,but denied alcohol or illicit drug use. Current medications included albuterol nebulizer, aspirin, alprazolam, levothyroxine,simvastatin, and over-the-counter Excedrin (acetaminophen, aspirin, caffeine).