Given these changes from the original case, what is your diagnosis?
What is your diagnostic explanation?
As compared to the long case, this is a 60 year old woman who presents with a CC of cough, and the cough is worse in the morning. In the past few mornings she has coughed up blood. She noted increased shortness of breath with exertion and feels slightly fatigued. She denies fevers, chest pain or chest congestion. She has seasonal allergies and occasional headaches too, and denies any recent travel. She is treated with Lisinopril, Metformin, and Simvastatin for hypertension, DM Type 2, and hypercholesterolemia respectively. He has a 120 pack year smoking history. Mother and father had hypertension and diabetes.
PE: Ill-appearing woman who appears somewhat short of breath. BMI 28.3. VS – HR82, BP 140/82, RR20, T 98.2F. No abnormalities on physical exam.
Lab: Chest X-ray shows a small, round mass in the left upper lobe of the lung which appears homogenous in density.