A Curious Case of Chronic Cough

Question 1: A 29-year-old male came to the outpatient department with chief complaints of cough with expectoration and dyspnea on exertion on and off for 2 years. Chest X-ray and high-resolution computed tomography (HRCT) thorax were done. Routine blood investigations were within normal limits, except an elevated white blood cell count (14,200/mm3). Choose correct diagnostic option based on the chest X-ray and HRCT images? [Figure 1].Figure 1: X-Ray and HRCT Images of Thorax(A) Pulmonary artery hypoplasia. (B) Partial endobronchial obstruction. (C) Poland syndrome. (D) Swyer–James–MacLeod syndrome. Answer of Last Bulls Eye Challenge Atoll Sign Explanation Central ground glass opacity surrounded by a crescent or ring of consolidation on HRCT.[1] Atoll sign is also known as reverse halo sign.[2] Atoll sign is seen in approximately 20% of patients with cryptogenic organizing pneumonia.[3] The atoll sign was first described in patients with cryptogenic organizing pneumonia and was originally believed to be specific for that diagnosis.[3-5] However, this computed tomography appearance has since been reported in a large number of pulmonary disorders, including granulomatosis with angiitis, lymphomatoid granulomatosis, sarcoidosis, zygomycosis, histoplasmosis, aspergillus, pneumocystis jiroveci pneumonia, nonspecific interstitial pneumonia, and pulmonary paracoccidioidomyocosis.[6,7] Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.