Recurrent pneumothorax and adenopathy.

A 34-year-old nonsmoking African-American woman with a history of childhood asthma presented to her internist with 25 h of right-sided chest pain and shortness of breath. The initial physical examination was remarkable for a respiratory rate of 28; heart rate, 140 bpm; and absent breath sounds on the right. A portable chest radiograph revealed a large right pneumothorax. She was treated with tube thoracostomy with resolution of the pneumothorax. Two weeks after hospital discharge, a follow-up posteroanterior and lateral chest radiograph better revealed bilateral hilar adenopathy and diffuse increased interstitial markings (Fig 1). These coarse reticular infiltrates were more predominant at the bases. A computed tomography (CT) scan was performed that showed innumerable thin-walled cysts throughout the lungs again with a basilar predominance (Fig 2, top). They ranged in size from a few