Interstitial Densities Following Radiotherapy

R.D. is a 51-year-old man who presented to his local rural hospital in April 2002 with facial flushing, shortness of breath, cough, and a syncopal episode. He reported that his symptoms had persisted for three weeks, and he had been treated for a sinus infection three times prior to this admission. Because of fatigue, he was being evaluated for possible thyroid dysfunction. He also had a past medical history of long-term smoking and coal dust exposure. A chest x-ray (see Figure 1) and a computerized tomography (CT) scan were ordered. A large mediastinal mass was noted as well as marked obstruction of the superior vena cava from the mass.