Intrathoracic mass in a 34 year old cystic fibrosis patient.

In 1988, a 29 year old man presented with recurrent purulent bronchitis and sinusitis; cystic fibrosis (CF) was diagnosed. Repeated sweat tests were compatible with the diagnosis of CF: Clwas 83 (left) and 82 (right) mmol·L-1, and Na+ was 95 (left) and 94 (right) mmol·L-1. Chest radiograph at that time was normal. A computed tomography (CT) scan revealed small, tubular bronchiectasis in both upper lobes. Ventilatory function tests showed a mild airway obstruction (forced expiratory volume in one second (FEV1) 81% predicted, and FEV1/forced vital capacity (FVC) 66%), with 15% reversibility. Residual volume (RV) was 132% predicted. Lung capacities and CO transfer factor were normal. The patient was atopic, (total immunoglobulin E (IgE) >1,000 kU·L-1; radioallergosorbent test (RAST) ++++ for Aspergillus fumigatus, +++ for D. pteronyssinus, ++ for Cladosporum herbarum, and + for grass pollen) and precipitation antibodies against A. fumigatus were present (two precipitation lines). Skin-prick tests were positive for D. pteronyssinus and D. farinae, and negative for all other aero-allergens, including Aspergillus fumigatus. The patient had azoospermia. Treatment consisted of aerosols (N-acetylcysteïne, twice daily), and regular intake of antibiotics, combined with physical therapy in case of purulent bronchitis. CASE FOR DIAGNOSIS