Clinical presentation

A healthy 34-year-old woman had a 1-month history of dyspnoea and an abnormal chest radiograph. A course of erythromycin was unhelpful. Further details of her history did not suggest an aetiology. Physical examination showed only mild hypoxia on exertion.

A high-resolution chest CT scan was performed, revealing a left apical and hilar mass extending posteriorly to encase the lung, particularly along the mediastinal aspect (fig 1). There was also bilateral airspace opacification in a bronchocentric distribution. Bronchoscopy and thoracentesis were non-diagnostic.

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Figure 1

 Coronal CT scan of the chest showing ground glass and dense airspace opacification in a bronchocentric distribution throughout both lungs. There is also left hilar enlargement and multiple pleural masses.

Question

What is your diagnosis?

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