Skill Checkup: A 53-Year-Old Woman With Dry Cough and a Lung Lesion

John C. Leighton Jr, MD, FACP


September 01, 2022

The Skill Checkup series provides a quick, case-style interactive quiz highlighting key guidelines- and evidence-based information to inform clinical practice.

A 53-year-old woman in the United States, a never-smoker, had been complaining of a dry cough during the previous 2 months. She underwent a CT scan of the thorax and abdomen, which revealed the presence of a lung lesion in the left upper lobe with unilateral lymph-node enlargement at station 4L. Bronchoscopy with fine-needle aspiration of the station 4L lymph node was performed, and the results indicated TTF1-positive adenocarcinoma. These results prompted the physician to order a PET scan, which revealed unequivocal disease at both the primary tumor and mediastinal lymph node, indicating stage IIIA disease.

The patient started a course of paclitaxel and carboplatin with radiation therapy. Soon thereafter, however, she complained of worsening of the cough with onset of occasional hemoptysis. The rapid worsening of her clinical condition after one course of chemotherapy and radiation suggests the presence of hyperprogressive disease.


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