65-year-old male, former smoker (25 pack-years, quit 12 years ago) presented complaining of persistent lower back pain, extreme fatigue, shortness of breath, and a 25-lb weight loss in the past 6 months.
PMH includes rheumatoid arthritis which significantly limits his physical activity.
Back pain also limited the patient’s daily activity.
MRI of the spine showed evidence of multiple lesions, but none were causing cord compression.
CT of the chest showed a 4-cm mass in the left lung, with enlarged bilateral mediastinal lymph nodes.
The MRI of the brain revealed no metastases.
ECOG PS was assessed to be 2.
He underwent an endobronchial ultrasound-directed biopsy of the mediastinal lymph nodes.