Pulmonary Medicine Quiz

Prepared by Boris Medarov, MD, Fellow, and Leonard J. Rossoff, MD, Chief, Division of Pulmonary and Critical

Care Medicine, Long Island Jewish Medical Center, Albert Einstein School of Medicine, New Hyde Park, NY

A 68-year-old woman and former heavy smoker was diagnosed with left upper-lobe lung adenocarcinoma 4 years ago. She received radiation therapy, followed by lobectomy and vascular sleeve resection. About 1 year later, she required iridium¹⁸² high-dose radiation brachytherapy and a 6-cm metallic stent in the distal trachea for local tumor recurrence.

Now, 3 years later, she presents with increasing, productive mucopurulent cough. Chest x-ray reveals postoperative and radiation changes, with no clear interval difference. Contrast-enhanced chest computed tomography (CT) scans are ordered (Figure).

What's Your Diagnosis?

What's the Diagnosis?

• Dislocation of the tracheal stent
• Tracheomediastinal fistula
• Extensive bronchiectasis
• Necrotizing pneumonia

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