A CT scan shows a new right lower lobe (RLL) nodule measuring 2 x 1.6 cm and without associated hilar or mediastinal lymphadenopathy. The RLL is fludeoxyglucose avid with a maximum standardized uptake value (SUV) of 10.2 on PET imaging. Navigational bronchoscopy with biopsies of the RLL nodule demonstrates invasive, moderately differentiated squamous cell carcinoma. Endobronchial ultrasound-guided staging of the mediastinum is negative for lymph node involvement. Cytomegalovirus and Epstein-Barr virus status of both donor and recipient are positive. His immunosuppression regimen includes cyclosporine, mycophenolate mofetil, and prednisone.