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3043 Radiology

A 60-year-old man with a history of COPD and old TB is seen with mild hemoptysis and chronic cough. He is HIV negative and has been ill for about 2 wk. Vital signs: pulse 110 bpm; temperature 101degF; respirations 24/min; blood pressure 108/70 mm Hg. No skin lesions are noted. Laboratory data: Hb 14 g/dL; HCA 42%; WBCs 8.7/uL; BUN 24 mg/dL; creatinine 0.8 mg/dL; sodium 131 mEq/L; potassium 4.3 mEq/L. ABGs on RA: pH 7.37; PCO2 43 mm Hg; PO2 87 mm Hg. Sputum tests reveal numerous AFBpositive organisms on smear. Spirometry shows an obstructive ventilatory impairment with marginal reversibility. CXR is shown . Among the choices listed, the most likely diagnosis is

ALung abscess
BNon-TB mycobacteria
CActinomycosis
DAspiration pneumonia
Radiology
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