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Pulmonary puzzles
An unusual cause of haemoptysis in a smoker
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  1. M J McDonnell1,
  2. J Garvey,
  3. D G Lohan1,2,
  4. G J O'Sullivan2,
  5. K Redmond3,
  6. J E Jackson4,
  7. R M Rutherford1
  1. 1Department of Respiratory Medicine, Galway University Hospital, Newcastle Road, Galway, Ireland
  2. 2Department of Radiology, Galway University Hospital, Galway, Ireland
  3. 3Department of Cardiothoracic Surgery, Mater Miscorderae University Hospital, Eccles Street, Dublin 7, Ireland
  4. 4Department of Imaging, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
  1. Correspondence to Dr Robert M Rutherford, Department of Respiratory Medicine, Galway University Hospitals, Newcastle Road, Galway, Ireland; Robert.rutherford{at}hse.ie

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Case description

A 33-year-old Caucasian male smoker presented to our rapid access lung cancer clinic with a single episode of moderate haemoptysis and no other respiratory or systemic symptoms. There was no relevant past medical history. As an adopted child he was unaware of any significant family history. The only finding on clinical examination was decreased air entry on the right side. Laboratory tests were all normal. Chest x-ray demonstrated a small right hemithorax with marked mediastinal displacement to the right, increased soft tissue opacity adjacent to the right side of the mediastinum causing widening of the right paratracheal stripe and loss of silhouette of the right heart border, and increased interstitial opacity throughout the right lung (figure 1A). A CT scan of the thorax confirmed the presence of a large amount of abnormal low attenuation soft tissue around the right side of the mediastinum, which also involved the azygo-oesophageal space causing considerable thickening of the oesophageal wall (figure 1B), a …

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