A 16-year-old boy with chronic renal failure secondary to membranoproliferative glomerulonephritis was admitted for cadaveric renal transplantation. There were no complaints referable to the chest. His initial renal transplant was two years earlier and was complicated by episodes of acute and chronic rejection. While he was receiving immunosuppressives, cytomegalic virus pneumonia and disseminated cryptococcosis developed; these conditions both resolved with appropriate therapy.
Physical examination showed that the patient was a listless cushingoid adolescent with no respiratory distress and no pulmonary rales.
Laboratory studies disclosed the following findings: normal WBC and differential cell counts; blood carbon dioxide, 16 mg/dL; serum urea nitrogen, 129 mg/dL; serum phosphorus, 10 mg/dL; serum calcium, 6.2 mg/dL; total serum protein, 4.1 g/dL; and serum albumin, 1.9 g/dL. A chest roentgenogram was obtained at admission (Fig 1), and a coned view of middle of the right lung was also obtained (Fig 2). Chest roentgenograms, six months earlier,had