Case

A 44-year-old man presented to hospital with haemoptysis and progressive dyspnoea. Examination revealed room air oxygen saturation of 91% with diffuse chest crackles, gynaecomastia and hepatosplenomegaly. Scrotal examination was unremarkable. Radiological investigations revealed numerous bilateral pulmonary nodules of variable size (cannonball appearance) (figure 1), gynaecomastia (figure 2A), hepatosplenomegaly and a large retroperitoneal mass (figure 2B). Scrotal ultrasound showed no abnormalities.