A 56-yr-old woman, who is known to suffer from RA, complains she has had recurrent
haemoptysis for over 5 yrs. She has never smoked and only takes NSAIDs. According to her, she
coughs up phlegm every day and at times this contains streaks of fresh blood. She has no known
respiratory disease, but tends to get frequent chest infections that are relieved by a course of
antibiotics. What is the most likely Dx?
A. Lung cancer
B. Bronchiectasis
C. TB
D. Pulmonary embolism
E. Atypical pneumonia
Answer:
B. Bronchiectasis
Discussion: Some 3–4% of pts with RA develop bronchiectasis. This is characterized by recurrent
haemoptysis. The history of expectorating phlegm on most days and frequent chest infections
are suggestive of the diagnosis. An High Resolution CT scan of her lungs will establish the Dx.
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