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Ann Saudi MedAnn Saudi MedAnnals of Saudi Medicine0256-49470975-4466King Faisal Specialist Hospital and Research Centre 1739638010.5144/0256-4947.2006.484asm-6-484What's Your Diagnosis?Adult with cough and bilateral ankle swelling Parameswaran Bimal Al Dossary Jamila Salmaniya Medical Complex, Manama, BahrainCorrespondence and reprint requests: Bimal Kumar Parameswaran, MD, Department of Radiology, Salmaniya Medical Complex, Manama, Bahrain, T: +973-1-728 9008, F: +973-1-728 9030, drbimalkumar@yahoo.comNov-Dec 2006 26 6 484 485 Copyright © 2006, Annals of Saudi Medicine2006This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
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A 53-year-old Bahraini businessman, known to have hypertension and diabetes, presented with complaints of cough with scanty white sputum, bilateral knee pain and painful bilateral ankle swelling, all of 2-months duration. He also had streaky hemoptysis of 2 days duration. He was a chronic smoker who had smoked about 30 cigarettes a day for the past 30 years and also complained of weight loss of about 5 kilograms over the past few months. General examination revealed clubbing of the fingers of both hands and bilateral symmetric tender pitting edema of the lower limbs. There was no thickening of the skin of the face. The breath sounds were reduced over the right mammary and inframammary region with dullness on percussion. Examination of other systems were normal.

Figure 1 is an anteroposterior [AP] radiograph of both knees and Figure 2 is a lateral radiograph of both ankles. What do these radiographs show? Figure 3 is a frontal radiograph of the chest and Figure 4 is a selected image from a CT scan of the chest. Do these lead you to a specific diagnosis?

Answer on page 489.

Figure 1 Anteroposterior [AP] radiograph of both knees.

Figure 2 Lateral radiograph of both ankles.

Figure 3 Frontal radiograph of the chest.

Figure 4 CT scan of the chest.