A 68-year-old woman and former heavy smoker was diagnosed with left upper-lobe lung adenocarcinoma 4 years ago. She received radiation therapy, followed by lobectomy and vascular sleeve resection. About 1 year later, she required iridium¹⁸² high-dose radiation brachytherapy and a 6-cm metallic stent in the distal trachea for local tumor recurrence.

Now, 3 years later, she presents with increasing, productive mucopurulent cough. Chest x-ray reveals postoperative and radiation changes, with no clear interval difference. Contrast-enhanced chest computed tomography (CT) scans are ordered (Figure).

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