45 yr old presents with a 3.1 cm left lower lobe mass. He has a 20 year history of smoking one to two packs of cigarettes a day. Physical exam is unremarkable.
CT of the chest reveals ipsilateral mediastinal lymphadenopathy with lymph nodes measuring 1.3. PET/CT scan shows activity in the left lower lobe mass without other abormality. MRI of the brain with gadolinium is negative. PFTs reveal a FEV1 of 2.5 liters.
During the course of his evaluation he develops a symptomatic pericardial effusion. Pericardiocentesis is performed and the cytology reveals malignant cells, adenocarcinoma favored.