A nonsmoking 56-year-old woman has weight loss and a chronic cough.
A 56-year-old housewife seen at your office has a 3-month history of chronic, nonproductive cough, which has recently become unresponsive to over-the-counter liquid cough suppressants. She denies having shortness of breath, wheezing, chest pain, hemoptysis, fever, chills, sore throat, hoarseness, or postnasal drip. Her cough is independent of time of day, physical activity, weather conditions, and exposure to dust or household cleaning agents. Furthermore, her daughter's cigarette smoke does not seem to aggravate the cough. She notes that she has been feeling fatigued and, without dieting, has lost 18 pounds over the past 6 months.
Her past medical history is noncontributory. She does not smoke or drink alcohol and does not come in contact with any known chemical substances or irritants other than typical household cleaning agents. Her father died at age 65 of a myocardial infarction, and her mother had breast cancer at age 71. Her first husband died of a cerebrovascular accident 3 years ago. Newly remarried to a retired shipyard worker, she and her current husband live with her 28-year-old daughter and 9-year-old grandson in their New Hampshire home. She has not been outside the New England area for the last 5 years.
Results of the physical examination, including head, eyes, ears, nose, throat (HEENT) and chest examination, were normal. There is no cyanosis or clubbing of the extremities, and no palpable lymph nodes. Blood tests, including a complete blood count and chemistry panel, are normal, with the exception of a total serum calcium level of 12.7 milligrams per deciliter (mg/dL) (normal range: 9.2 to 11.0 mg/dL). However, a chest radiograph reveals a noncalcified, noncavitary 3.5-centimeter mass within the parenchyma adjacent to the right hilum. There are no other radiographic abnormalities. Results of a purified protein derivative (PPD) skin test for tuberculosis are negative. Urinalysis results are normal.
