Case 352

Medical history

A 70-year-old male patient with systemic arterial hypertension and chronic obstructive pulmonary disease, followed by pulmonary emphysema. Former smoker (40 years.pack of cigaretts). Two months ago, noticed worsening cough and dyspnea on his usual efforts. In a return consultation, a simple chest X-ray was requested. After three months of symptoms worsening, a chest computed tomography (CT) was requested.

Question 

Considering the clinical history and the imaging tests presented, what is the most likely diagnosis?

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