Lung Cancer

A 42 year old man with 3 month history of dyspnea and shortness of breath complains from weakness and malaise for one week.
He also had night sweats, wight loss (5kg/3M) and fever, in physical examination he had 3x3 firm, non-tender and fixed left anterior cerviacal lymphadenopathy. Fine crackles was heard in both lungs

In his CXR, miliary type nodular consolidations were seen in lung paranchyma that enhanced in both hilums.

A chest CT revealed diffuse micronodular opacity disseminated in both lung fields associated with a spiculated mass-like consolidation in posterobasal segment of LLL. There is also diffused mixed (lytic-sclerotic) bone lesion in all of the thoracic skeleton. Multiple small mediastinal and axillary lymphadenopathy are present.

These findings are in favor of disseminated metastatic lesions rather than infectious process like TB. Lung cancer as primary site must be considered.