LEFT UPPER LOBE MASS AND DIFFUSE RETICULAR-NODULAR INFILTRATE

We encountered a clinical problem in a young man who presented with a left upper lobe mass and a diffuse reticular-nodular infiltrate. We th ought me had appropriately applied Murphy's Law (the famed bank robber who ''went where the money is''), and Ockham's Razor (the philosopher William of Ockham [1285 to 1349]-''Entities are not to be multiplied beyond necessity'') as we rapidly diagnosed the lung mass with compute d tomography, scintography, and fine-needle aspiration. However, when his invaluable previous chest radiographs arrived, bronchoscopy with t ransbronchial biopsy, bronchoalveolar lavage, brushings, and postbronc hoscopy sputum revealed the more ominous diagnosis in this patient. Th is case illustrates the complementary nature of current imaging and br onchoscopy techniques; but, even more importantly, it demonstrates the value of the history coupled with the previous radiograph. Even an un usual case can provide lessons in cost containment.