A Elhoffy

I would like to present the case of a patient admitted to a tertiary hospital in Egypt with symptoms of lower respiratory tract infection. The interpretation of the patient’s baseline imaging and the decision regarding the best management were challenging. A man aged 28 years attended the emergency department with a 4-week history of symptoms of cough productive of small volumes of yellowish sputum, worsening chest pain and dyspnoea and few days’ history of vague left upper quadrant abdominal pain and constipation. He had a background of bronchial asthma and was a cigarette smoker, but he denied intravenous drug use. On examination, he was afebrile. Reduced breath sounds were noted on the left side and his abdomen was lax. Blood tests showed a C reactive protein (CRP) of 173 mg/L, a white cell count (WCC) of 11.5×10⁹/L, platelet count of 662×10⁹/L and serum albumin of 20 g/L. A chest radiograph showed multiple air fluid levels on left side with inconspicuous lung markings (figure 1A). He went on to have an urgent CT scan of the chest (figure 1B–E and online supplemental video). A test for human immune deficiency virus came back negative and a transthoracic echocardiogram was unremarkable.