Fatigue and dyspnea in a 71-year-old man with a pulmonary nodule

A 71-year-old man from ohio, presenting for his annual follow-up visit, reported chronic fatigue over several months that was now associated with dyspnea and occasional night sweats.The symptoms were now limiting his daily activities.His past medical history was notable for stage IB squamous cell carcinoma of the lung (T2N0M0), 1 treated 4 years earlier with robotic-assisted right upper lobectomy and lymph node dissection.Other comorbidities included chronic obstructive pulmonary disease (emphysema type), coronary artery disease, atrial fi brillation, hypertension, hyperlipidemia, and gastroesophageal refl ux disease.He was immunocompetent and a former smoker with a history of 32 pack-years.His physical examination was notable only for diminished breath sounds consistent with emphysema, without fever, cachexia, palpable lymphadenopathy, or digital clubbing.Laboratory studies were suggestive of mild anemia, with hemoglobin 12.2 g/dL (reference range 13-17).Computed tomography (CT) of the chest was performed.