Clubbing, Arthralgia and a Large Intrathoracic Mass

A 65-year-old man was referred to our department in 2008 for mild dyspnea. The patient was a never-smoker, and had no history of asbestos exposure. In 2006, he had presented an episode of fever, polyarthralgia and erythema of the fingers that resolved spontaneously; at that time the chest radiograph had demonstrated a dense opacity of the left base that was considered an infectious pneumonia ( fig. 1 ), with clinical improvement with antibiotic therapy and he was lost to follow-up. However, he subsequently presented with chronic arthralgia, mild fever, night-sweats and fatigue, which worsened progressively between 2006 and 2008. A rheumatologist considered the diagnosis of rheumatoid arthritis. Upon referral to our center, clinical examination demonstrated erythematous clubbing of the extremities of the fingers ( fig. 2 ) and toes, and dullness of the left hemithorax. The chest radiograph showed a left basal opacity ( fig. 3 ) that had increased in size when compared to 2006. A chest CT scan further showed a mass measuring 15 ! 11 cm in diameter, located in the basal area of the left Received: January 25, 2012 Accepted after revision: February 29, 2012 Published online: June 13, 2012