Pulmonary and Critical Care Medicine Q14

A 67-year-old man is evaluated in the emergency department with a 3-day history of weakness and nausea and a 2-week history of difficulty swallowing. He has lost 22.7 kg (50 lb) during the past year. He has no other symptoms. History is significant for a 30-pack-year history of smoking. He quit smoking 4 years ago. He takes no medications.

On physical examination, vital signs are normal. Lung examination reveals decreased tactile fremitus above the lower portion of the right lung as well as dullness to percussion and decreased breath sounds. His neurologic examination is normal.

Laboratory studies reveal a serum sodium concentration of 127 mEq/L (127 mmol/L).

A chest CT scan is shown.

Which of the following is the most likely diagnosis?

A Adenocarcinoma of the lung

B Malignant pleural mesothelioma

C Small cell lung cancer

D Squamous cell carcinoma of the lung

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