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Pulmonary puzzles
The leak and endobronchial peek
  1. Mohammed H AlShati
  1. Correspondence to Dr Mohammed H AlShati, Division of Respirology and Sleep Medicine, Department of Internal Medicine, Al-Adan Hospital, P.O. Box 46969, Ahmadi 64020, Kuwait; dr_alshatti{at}

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A 42-year-old man from Afghanistan was referred to hospital as a case of non-resolving pneumonia. He had fever and productive cough of thick white sputum for 4 months without response to antibiotics. There was no history of haemoptysis, sick contacts, recent travel, weight loss, substance abuse or HIV risk factors. He was a non-smoker with unremarkable family and environmental history.

On examination, he was febrile (temp=39.1°C) with stable haemodynamics. Oxygen saturation was 96% while breathing room air at rest and finger nail clubbing was absent. Chest auscultation revealed bronchial breathing on the left upper lung zone. The rest of his examination was unremarkable. Except for mild neutrophilic leukocytosis, complete blood count (CBC) was unremarkable. Moderate elevation of erythrocyte sedimentation …

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  • Acknowledgements I would like to thank Dr Munish Joneja for providing the pathology image.

  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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