PUZZLES Clinical presentation

To cite: Huang C-W, Kuo K-T, Lin C-M, et al. Thorax Published Online First: [please include Day Month Year] doi:10.1136/ thoraxjnl-2012-202335 A 74-year-old Asian female underwent a chest CT scan because of a pulmonary nodule observed on her chest radiograph (figure 1A). She complained of mild dyspnoea on exertion for few weeks. Her past history was significant for hypertension and obesity (body mass index 39 kg/m). Physical examination, electrocardiography (EKG), cardiac echogram and laboratory biochemistry were all unremarkable. Chest CT scan revealed a 3.6×2.8 cm solitary nodule locating at the tip of the lingual lobe with strong vascular enhancement demonstrated during contrast phase (figure 1B). The patient was afebrile and mildly anxious, and her blood pressure was 118/64 mm Hg. Since she was symptomatic without surgical contraindication, video-assisted thoracic surgery (VATS) exploration was proceeded. Under VATS, a bright-red and wellcircumscribed cystic lesion at the tip of the lingual lobe was noted (figure 2), and a wedge resection was performed.