A 60-year-old woman wants to establish care as a new patient at your clinic. She presents for an annual physical and has no current complaints.
Her medical history is significant for hypertension and remote uterine cancer, which was treated with a hysterectomy. She does report smoking a half-pack to one pack of cigarettes per day for “about 30 to 40” years.
Vital signs are normal. Overall, the complete physical examination yields no abnormal findings. Routine bloodwork, 12-lead ECG, and a chest radiograph are ordered. The last is shown. What is your impression?
The radiograph shows a moderate-size mass, measuring about 5 × 3 cm, at the medial portion of the right upper lobe, within the paratracheal region. This lesion should be treated as a neoplasm until proven otherwise. Contrast-enhanced CT is warranted, as well as prompt referral to a cardiothoracic surgeon.