A. Cancer
Considering the constellation of symptoms presented by the 65-year-old male patient, along with radiological findings and relevant history, the probability of lung cancer must be carefully assessed. The patient’s chief complaints include hemoptysis, fever, pleuritic chest pain, and weight loss. These symptoms, when observed together, raise significant concern for an underlying malignancy, particularly lung cancer. Hemoptysis, although not pathognomonic for lung cancer, is a concerning symptom often associated with malignancies of the lung parenchyma (9).
The LCTA revealed consolidations in the pulmonary parenchyma. Consolidations, especially when multifocal or persistent, are concerning for neoplastic processes such as lung cancer (10). While consolidations can be seen in various pulmonary conditions, including infectious etiologies like pneumonia, the presence of consolidations in conjunction with the patient’s symptoms and history warrants thorough investigation for malignancy.
Of significant relevance is the patient’s history of cigarette smoking. Cigarette smoking is the most significant risk factor for the development of lung cancer, accounting for most cases.
Considering the patient’s presentation of hemoptysis, fever, pleuritic chest pain, weight loss, consolidations on imaging, and a history of cigarette smoking, the probability of lung cancer is notably elevated. There are two primary types of lung cancer: non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) (11). NSCLC is further categorized into three subtypes: adenocarcinoma, squamous cell carcinoma, and large cell carcinoma (12). Adenocarcinoma is the most common form of lung cancer, particularly among smokers (12). It tends to occur in the outer regions of the lungs and is associated with a higher incidence in individuals with a history of smoking. Adenocarcinoma often presents with symptoms such as hemoptysis, cough, and weight loss (13).
B. Infectious diseases
Considering the clinical presentation, radiological findings, and regional epidemiology, the probability of infectious diseases such as tuberculosis (TB) and aspergillosis must be carefully considered.