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→Clinical Summary
Two months prior to admission, this 57-year-old white male underwent a routine physical examination. During the course of the examination, a lesion was found in the upper lobe of the right lung. Initially, the patient was treated for two weeks with ampicillin. He was then admitted to the hospital for further study. All studies including sputum studies for tubercle bacilli, bronchial washings, and bronchoscopy were negative and he was discharged.
Upon re-admission, a review of systems revealed the presence of mild dyspnea on exertion, accompanied by a slightly productive cough. Of interest was the fact that the patient had had a positive PPD test for the past 4 to 5 years, but this had never been evaluated. At this time, physical and laboratory examinations were unremarkable. Radiographic examination of the chest revealed a 2 x 2-cm density in the right lower lung field. A CT scan revealed several small cavities in this area. The patient underwent a thoracotomy, at which time a portion of the upper lobe of the right lung was removed. Examination of the cut surface revealed small white nodules measuring up to 0.2 cm in diameter.
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