Breathlessness with cough, malaise, and fever
A 62 year old woman presented with shortness of breath that had gradually worsened in three months. She had a productive cough of the same duration, intermittent fevers, malaise, and mild weight loss. She had no relevant occupational or drug history but had kept a budgerigar (parakeet) for the past 18 months.
On examination, her breath sounds were vesicular with no added sounds. A chest x ray (fig 1) and a high resolution computed tomogram (fig 2) were taken.