To the Editor: A 61-year-old woman with a prior history of extensive cigarette smoking and
vaping had been followed for 3 years due to the presence of diffuse upper lobe predominant
centrilobular and perifissural micronodules which had been stable on computed tomography
(CT) imaging for the last 3 years (Figs. 1A, B). However, the recent development of a
nonproductive cough with nonexertional dyspnea and an isolated decline in diffusing
capacity for carbon monoxide on pulmonary function testing prompted a concern for …