Editor: The recent strident debates in Radiology (1–4) on the effectiveness of computed tomography (CT) in screening for lung cancer have captured the radiologists’ attention, stirred controversy, and stimulated some much needed critical thinking. What is often missing from radiologists’ thoughts is firsthand experience with the clinical drama that follows screening or diagnostic tests. My personal anecdote is an example of the clinical aphorism that the only “normal” patient is one who has not yet undergone a complete work-up. It began innocently enough with a negative CT colonographic examination that was requested following my routine annual physical examination. Lurking outside the colon were a renal lesion, a 2-cm hepatic mass, and multiple 9–10-mm noncalcified nodules at both lung bases. Our observant radiologists saw them all. Further contrast material–enhanced CT scans of the abdomen demonstrated that the renal mass was a cyst. The nonenhancing liver lesion was not a cyst. Findings from high-spatialresolution lung CT revealed seven to eight noncalcified nodules in both lower lobes. A chest radiograph obtained in 1997 was negative.

Findings from the CT-guided liver biopsy showed only necrotic tissue; but the findings were not definitive. A positron emission tomographic (PET) scan was negative. After much debate, video-aided thoracoscopy was performed with an intercostal approach. Three wedge resections were performed on the right lung after the anesthesiologists had selectively collapsed it to aid the surgeons’ palpation of the lesions. Thorough evaluation by the pathologists resulted in a definitive diagnosis of Histoplasmosis capsulatum, with areas of noncalcified granulomata in all three lesions. I awoke in the recovery room after 5 hours, with a chest tube, a Foley catheter, a subclavian central venous catheter, a nasal oxygen catheter, an epidural catheter, an arterial catheter, subcutaneously administered heparin, a constant infusion of prophylactic antibiotics, and patient-controlled analgesia with intravenously administered narcotics. During the next 4 days, the tubes and the potent drugs were slowly removed, but the excruciating pain lingered on. However, the nurses were great, the hospital staff superb, the