Vivian Hayashi MD and Robert Smith MD, Mystery Quiz Section Editors
The patient is a 39yo male followed in pulmonary clinic for chronic breathlessness and intermittent sputum production, sometimes blood tinged. Symptoms were first noted eleven years earlier at which time pulmonary function testing revealed mixed obstructive and restrictive defects. The patient experienced some improvement with bronchodilators, occasional courses of oral steroids and antibiotics, but was never entirely free of his symptoms. Over an interval of ten years, the patient required several hospitalizations for treatment of breathlessness, pneumonia, and a spontaneous left-sided pneumothorax that required chest tube placement. He smoked half a pack per day for four years and quit seven years earlier. The patient worked from the ages of 20 to 24 in a quarry. Family history was non-revealing.
Current imaging is shown below.