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Pulmonary puzzles
A bloody bronchoscopy
  1. Karthi Srikanthan1,
  2. Husain Shabeeh2,
  3. Anthony De Souza3,
  4. Pallav Shah1,4
  1. 1Department of Respiratory Medicine, Royal Brompton Hospital, London, UK
  2. 2Department of Cardiology, Royal Brompton Hospital, London, UK
  3. 3Department of Cardiac Surgery, Royal Brompton Hospital, London, UK
  4. 4Department of Respiratory Medicine, National Heart & Lung Institute, Imperial College, London, UK
  1. Correspondence to Dr Pallav Shah, Department of Respiratory Medicine, Royal Brompton Hospital, London, SW3 6NP, UK; pallav.shah{at}imperial.ac.uk

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A 42-year-old male non-smoker presented to the emergency department with a 1-month history of fever. He had no medical history. He was treated with oral antibiotics for a presumed chest infection. Initial chest radiograph (CXR) is shown in figure 1A.

Figure 1

(A) Initial presentation chest radiograph (CXR). (B) Repeat CXR 2 weeks postpresentation. (C) CT chest 2 weeks postpresentation. (D) CXR at the time of rapidly worsening acute respiratory failure.

Two weeks later, he was seen in outpatients with fever, progressive dyspnoea and haemoptysis. Repeat CXR (figure 1B) was performed in addition to a chest CT (figure 1C).

He underwent urgent bronchoscopy and bronchoalveolar lavage (BAL). After the procedure, he was admitted due to persistent hypoxia.

Bedside observations: temperature 36.4°C, oxygen saturation 95% with Fio …

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