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A 74-year-old retired librarian was referred for assessment after a full-body CT, performed to investigate a 3-month history of persistent nausea and weight loss, incidentally identified a 10 mm left lower lobe nodule alongside small volume nodularity seen throughout the trachea and proximal main bronchi (figure 1). There was no previous thoracic imaging for comparison. She had a five pack-year smoking history and reported no preceding respiratory disease or symptoms. Her medical background was otherwise unremarkable. She appeared well in clinic; physical examination, basic spirometry (FEV1 131%, FVC 133% predicted) and flow-volume loops were normal. A subsequent positron emission tomography-CT scan demonstrated physiological uptake only and no areas of abnormality. Following MDT discussion it was recommended to obtain histopathological samples via bronchoscopy given the history of unexplained weight loss and extent of the nodularity within the large airways.