Photoclinic

The patient was a 32 years old non-smoker, non-alcohol user man who presented to Shahid Motahari Clinic of Namazi Hospital with cough and fever and right side pleuritic chest pain since 3 weeks ago with gradual onset and progressive in nature, that with recognition of pneumonia received antibiotic therapy but his condition did not improve. There was history of recurrent pneumonia 2 years ago. There was no history of hemoptysis and gastroesophageal reflux, abdominal pain, melena, nausea, or vomiting. On the day of hospital admission, the patient was hemodynamically stable with low grade fever, normal bilateral breath sounds without any wheezes or crackles of the lung. Neurologic and cardiovascular systems were all within normal limits. Laboratory data revealed a white blood cell count of 12.5 × 103 cells/μL, hemoglobin of 12.8 g/dL, and a platelet count of 354 000 cells/μL electrocardiography was usual. Chest X-ray showed the presence of an ill-defined density in the right lower lobe. Subsequent Computed Tomography (CT) scan with contrast showed centrilobular ground glass opacifications contained within the right lower lobe (Figure 1) and a 3-dimensional reconstruction CT angiography image revealed the dual arterial blood supply vessels originating from both the descending thoracic and the abdominal aortic arteries (Figure 2).