On physical examination, he was afebrile. BP was 152/94 mm Hg, heart rate was 92 beats/min, and respiratory rate was 16 breaths/min. The remainder of his examination was significant only for occasional crackles heard over the left chest. Blood test results, including a CBC, chemistry panel, and hepatic functions, were within normal limits. A chest radiograph and CT of the chest (Fig 1, 2
) showed bilateral peripheral nodular opacities. The CT scan showed that the nodules were often poorly defined and varied in size; some were coalescent, some contained air bronchograms, and one nodule was cavitating. No significant mediastinal or hilar adenopathy was noted.