Adult with cough and bilateral ankle swelling

Ann Saudi Med 2006;26(6):484-485 A 53-year-old Bahraini businessman, known to have hypertension and diabetes, presented with complaints of cough with scanty white sputum, bilateral knee pain and painful bilateral ankle swelling, all of 2-months duration. He also had streaky hemoptysis of 2 days duration. He was a chronic smoker who had smoked about 30 cigarettes a day for the past 30 years and also complained of weight loss of about 5 kilograms over the past few months. General examination revealed clubbing of the fingers of both hands and bilateral symmetric tender pitting edema of the lower limbs. There was no thickening of the skin of the face. The breath sounds were reduced over the right mammary and inframammary region with dullness on percussion. Examination of other systems were normal. Figure 1 is an anteroposterior [AP] radiograph of both knees and Figure 2 is a lateral radiograph of both ankles. What do these radiographs show? Figure 3 is a frontal radiograph of the chest and Figure 4 is a selected image from a CT scan of the chest. Do these lead you to a specific diagnosis?