Hoarseness and cough in a 67-year-old woman.

BUMC PROCEEDINGS 2004;17:469–472 A 67-year-old white woman presented with an approximately 1-month history of hoarseness and nonproductive cough. She had quit smoking 20 years earlier and denied chest pain and dysphagia. She was referred to an otorhinolaryngologist for further assessment. A computed tomography (CT) scan of the neck and chest was then requested. Contrast-enhanced CT images of the neck and chest are displayed (Figures 1–4). In addition, a positron emission tomography scan (not shown) revealed increased uptake in the aorticopulmonary window lymph node and the left lung nodule. A thoracic surgeon was consulted for fiber-optic bronchoscopy and mediastinoscopy. On bronchoscopic evaluation, only mild atrophy of the bronchial mucosa with no endobronchial mass was visualized. Further examination with a mediastinoscope revealed a solid and immobile lymph node complex in the aorticopulmonary window. Multiple biopsies of this lymph node complex were obtained. What is the most likely diagnosis? Hoarseness and cough in a 67-year-old woman