Abstract :
Presenting features
A healthy 44-year-old man presented to the Johns Hopkins Hospital after two episodes of nonpurulent hemoptysis, each consisting of approximately one-half cup of blood. The episodes were painless and were preceded by minimal coughing. The blood was bright red and without clots. He denied a recent history of upper respiratory tract infection, chest trauma, chest pain, or nasal/sinus disease. He had a chronic nonproductive “smoker’s cough.” He denied a recent history of fevers, chills, night sweats, hematuria, joint pains, epistaxis, or weight loss, and had no allergies. His past medical history was notable for neurogenic diabetes insipidus and diet-controlled diabetes mellitus. His only medication was intranasal desmopressin acetate. He smoked two packs of cigarettes daily for more than 20 years and rarely drank alcohol.
On physical examination, he was afebrile, with normal heart rate and blood pressure. His oxygen saturation was 94% on room air, and his respiratory rate was 16 beats per minute. His lungs were clear to auscultation bilaterally, without evidence of crackles or wheezes. He had bilateral digital clubbing. His white blood cell count was 10,770/mm3, with a normal differential. His hematocrit was 46%, and his platelet count was normal. Blood chemistries and urinanalysis were normal. A posteroanterior and lateral chest radiograph obtained on admission demonstrated moderate diffuse interstitial fibrosis involving the upper and lower lung (Figure 1A and 1B ).
Figure 1A and 1B. Posteroanterior (PA) and lateral chest radiographs demonstrating bilateral interstitial infiltrates involving the upper and lower lung fields. The lung bases appear to be spared on the PA image.
Figure 2A and 2B. Representative images from a high-resolution chest computed tomogram demonstrating cystic lesions and interstitial thickening in the lung parenchyma of the upper lobes.
What is the diagnosis?
