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A 73-year-old man was admitted with dyspnoea and facial oedema. He was previously healthy with a smoking history of 40 pack-years. A CT scan of the chest showed a peribronchial soft tissue mass in the central portion of the right upper lobe and conglomerated enlarged multiple lymph nodes in the right hilar, subcarinal, paratracheal and prevascular areas with superior vena cava (SVC) obstruction (fig 1A). A focal fibrotic lesion was also noted on the right upper lobe above the lung mass, suggesting post-inflammatory change (fig 2A). Small cell lung cancer was confirmed by percutaneous needle aspiration biopsy. Two cycles of combination chemotherapy with etoposide (100 mg/m2, day 1–3, every 3 weeks) and carboplatin (area under the curve 6, day 1, every 3 weeks) were given after 10 fractions of palliative radiotherapy to relieve SVC obstruction, leading to marked improvement (fig 1B). His dyspnoea and facial swelling also improved without any new symptoms such as fever or purulent sputum. However, a new 1.8 cm-sized lung nodule with central low density appeared on the site where the focal fibrosis had previously existed (fig 2B, C).
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Competing interests: None.