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Endgames Spot Diagnosis

A young woman with upper lobe predominant bronchiectasis

BMJ 2019; 364 doi: (Published 10 January 2019) Cite this as: BMJ 2019;364:k5244
  1. Leonard E Riley, pulmonary and critical care medicine fellow,
  2. Anupa P Nadkarni, assistant professor of pulmonary and critical care medicine
  1. Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida College of Medicine, Gainesville, FL, USA
  1. Correspondence to LE Riley Elmer.Riley{at}

A 26 year old woman presented with a 10 year history of recurrent lower respiratory tract infections, productive cough, progressive dyspnoea on exertion, and difficulty gaining weight. She had no history of loose or frequent bowel movements, or abdominal pain, and did not smoke. She had not been in contact with any sources of tuberculosis and had no family members with chronic pulmonary conditions. Her body mass index was 18.9 kg/m2, lung sounds were clear, and there was no evidence of nail clubbing. Chest radiography and computed tomography revealed upper lobe predominant bronchiectasis (fig 1, arrow) and airways with mucoid impaction (fig 1, arrowhead). …

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