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Case Records of the Massachusetts General Hospital
Weekly Clinicopathological Exercises
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Volume 331:1761-1767 December 29, 1994 Number 26
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Case 46-1994— A 35-Year-Old Smoker with an Air-Fluid Level in an Upper Lobe Bulla
Melvin D. Burton, and Eugene J. Mark

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Presentation of Case

A 35-year-old man was admitted to the hospital because of increasing exertional dyspnea, recent arthralgia and digital clubbing, and a questionable fungus ball in the right lung.

The patient had been well until five years earlier, when he began to have increasing exertional dyspnea. Four months before admission arthralgia developed, and his mother, who had pulmonary emphysema, observed that he had digital clubbing. Two months later he consulted a physician. Radiographs of the chest (Figure 1) showed hyperinflated lungs and bilateral upper-lobe bullae; there was a lobulated soft-tissue mass with an air-fluid level within a large bulla in . . . [Full Text of this Article]

Differential Diagnosis

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Dr. Melvin D. Burton's Diagnoses

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