When the patient was 72 years old, she was examined for cough and dyspnea. Due to a slightly elevated D-dimer (a fibrin degradation product) level, a chest computed tomography (CT) scan with angiography was performed to exclude pulmonary embolism (PE). A non-specific nodule (7 mm in diameter, possibly a lymph node) was found in the lower lobe of her right lung.
At the age of 73 years, the patient was admitted to the Helsinki University Hospital (HUH; Jorvi Hospital, Espoo, Finland) emergency department (ER) after experiencing a couple of weeks of dyspnea, coughing, abdominal discomfort, and difficulties eating normally. Chest x-rays showed pleural fluid on the right side, suggesting pleuritis, empyema, or malignancy. The CT scan revealed pleural fluid resembling empyema, thickening of the mediastinal pleura, and some nodules on the right side of the interlobular pleura (Figure 2A). These results suggested malignancy or tuberculosis (TB), but neither malignant cells, TB, nor other bacteria were found in the pleural fluid samples of the patient. An abdominal CT scan detected a mass (initially suspected to be a pseudotumor; size: 4.7 cm x 6.3 cm x 7.5 cm; Figure 2B) associated with her left THA. A thoracoscopy for pleural biopsies was scheduled. Following a prolonged course of antibiotic treatment, her condition and infection markers improved, and the planned thoracoscopy was canceled based on an oncology consultation.