X ray shows bilateral nodular shadow with cavitary lesion i/v/o clinical s/s and lab investigation-possibility of wegener granulomatosis exists. CT scan shows multiple bilateral cavitary lesions. HPE- Histiocytes and giant cells surrounding a central necrotic zone. Vasculitis: neutrophils and lymphocytes involving aeriole wall. Recurrent sinusitis with hemoptysis raises following differential diagnosis: Acute bronchitis Wegener granulomatosis Churg strauss syndrome Goodpasture syndrome Bronchogenic carcinoma Upper and lower respiratory symptoms. With significant cxr and HPE , elevated ESR and cANCA positivity is suggestive of WEGENER granulomatosis as the diagnosis.