A 72 year old Caucasian female presented with dyspnea on exertion. The patient was a former smoker with a 2-3 packs per day smoking history for 50 years, and had quit just six months back after an episode of chest pain secondary to GERD. PET/CT scan revealed a hypermetabolic well-circumscribed smoothly lobulated pulmonary nodule in the right middle lobe measuring 18 x 19 mm with a max SUV of 4.1. This nodule had slightly increased in size since 2004 when it measured 14 x 15mm. An endobronchial ultrasound guided (EBUS) biopsy with on-site touch-prep evaluation (ROSE) and bronchial washing were performed, followed by segmentectomy of right upper lobe.