An incidental finding in a 34-year-old male under investigation for haemoptysis

Laboratory examination included the following: white blood cell count 8.28 g?L with 43% neutrophils; haemoglobulin 16.3 g?L; haematocrit 47%; erythrocyte sedimentation rate 1 mm in the first h and C-reactive protein 1.55 mg?L. The results of renal function tests and biochemistry were within normal limits. Sputum specimens for culture and sensitivity and total blood count were negative. A plain chest radiograph and computer tomography (CT) of the thorax were performed (fig. 1a–c). Further investigations including a1 antitrypsin, pulmonary function and bronchoprovocation tests were normal. Oral examination and gastroscopy were within normal limits and did not reveal any source of bleeding. A bronchoscopy was performed (fig. 1d) and aspirates demonstrated a positive culture of Haemophilus influenzae, which was sensitive to amoxicillin.