A 62-year-old man with 40 pack year smoking history was diagnosed with a 2.9 cm Stage IV EGFR positive adenocarcinoma of the RUL with hypermetabolic activity on positron emission tomography-computed tomography (PET-CT). The patient underwent target immunotherapy with afatinib. Re-staging scans demonstrated decrease in size of the known RUL malignancy but increasing area of consolidation in the RLL suggesting a narrowed bronchus intermedius.