No abstract

A young man with bronchial asthma and an abnormal chest X-ray A S Kashyap, S Kashyap A 29-year-old man with bronchial asthma of 5 years duration was using inhaled salbutamol. In view of recurrent exacerbations, he had been put on oral prednisolone 20 mg/day for the last year. He did not smoke tobacco or drink alcohol. He had no other complaints. Clinically he had moon facies, buValo hump, centripetal obesity, purple striae on flanks and proximal myopathy. His blood pressure was 140/100 mmHg. Chest examination revealed polyphonic rhonchi in all areas. The rest of the general and physical examination was normal. Investigations revealed a normal haemogram, urinalysis, fasting and post-prandial plasma glucose, serum sodium, potassium, calcium and phosphate levels. Pulmonary function test showed an obstructive pattern. His chest X-ray (postero-anterior) is shown in figure 1. Chest X-ray a year earlier had been normal. Serum cortisol levels were 130 nmol/l at 08.00 h (normal 140-690 nmol/l) and 76 nmol/l at 16.00 h (80-330 nmol/l). Urine 24-hour calcium was 3.2 mmol (< 3.8 mmol). Questions1 What are the abnormalities seen on the chest X-ray? 2 What is the pathophysiology of these abnormalities ?Figure Chest X-ray (postero-anterior)Postgrad Med J 2000;76:41-60