The episodes last 15-30 minutes and often occur when he is emotionally upset. They are not related to exertion. During the episodes, the breathing difficulty is described as an inability to fill the chest enough. He denies wheezing. Past history and review of systems are not contributory.
Physical examination is entirely normal except for occasional sighing respiration.
Complete blood count, urinalysis, chest X-ray, electrocardiogram, and spirometry are normal. A 65-year old Caucasian male has a long history of chronic exertional dyspnea and a well documented diagnosis of chronic obstructive pulmonary emphysema. His ventilatory capacity is only one-third that predicted for a man of his age and body size. Studies fail to indicate the cause of this nodule and on April 10 he undergoes surgery for removal of the right upper lobe. The nodule proves to be a small cancer and it appears that the entire tumor has been removed.