Intended for healthcare professionals

Endgames Spot Diagnosis

A man with COPD, fever, and leucocytosis

BMJ 2015; 351 doi: (Published 13 November 2015) Cite this as: BMJ 2015;351:h6067
  1. Raghav Murthy, cardiothoracic surgeon1,
  2. Kemp Kernstine, chairman2
  1. 1UT Southwestern Medical Center, Dallas TX 75390, USA
  2. 2Department of Thoracic Surgery, UT Southwestern Medical Center
  1. Correspondence to: R Murthy raghavamurthy{at}

A 68 year old man with severe chronic obstructive pulmonary disease (COPD), who was on home oxygen and still smoked, presented to the emergency room with fever, fatigue, and leucocytosis (14×109 white blood cells/L). Computed tomography was performed (fig 1). What is the diagnosis?

Fig 1 Sagittal computed tomography image


An infection within a giant bulla.


Infections within a …

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