An Asymptomatic 42-Year-Old Woman With Randomly Distributed Semicalcified Pulmonary Nodules

A 42-year-old woman with a 25 pack-year smoking history, who quit 5 years prior to presentation, was referred to our outpatient clinic for reevaluation of multiple bilateral pulmonary nodules first identified 4 years earlier on chest computed tomography, performed following a self-limited flu-like illness with transient rash and nonproductive cough. Her symptoms resolved without intervention, and she remained clinically stable in the years that followed, with only occasional episodes of dry cough; however, the radiologic findings and her medical history prompted progressive diagnostic workup. Her medical history included non-Hodgkin lymphoma treated with chemotherapy 9 years before referral, with a documented relapse 5 years earlier and no evidence of active disease in the preceding 4 years. She had undergone total thyroidectomy for benign thyroid nodules 8 years before referral and partial nephrectomy for clear cell renal carcinoma 3 years earlier. At the time of referral, she was receiving thyroid hormone replacement therapy and a long-acting beta-agonist/long-acting muscarinic antagonist inhaler prescribed by her general practitioner for intermittent cough. She had no known TB exposure, no significant travel history, and no environmental or domestic risk factors, but reported occupational exposure from prior work in a charcoal grill restaurant. She had no history of aspiration episodes and reported no symptoms suggestive of chronic aspiration or dysphagia. Persistent abnormalities on serial imaging prompted extensive investigation over the years, including 2 surgical biopsies and multiple diagnostic studies, none of which yielded a definitive diagnosis. Despite the persistent radiographic findings, including nodules of varying size and semicalcified appearance, her clinical status remained stable, and no treatment had been initiated. She was ultimately referred to the department of respiratory medicine and admitted for further evaluation.