CASE
A 46-year-old man went to the emergency department (ED) of a local hospital complaining of joint pain, low-grade fever, and occasional chills. He received a diagnosis of arthritis and was treated and discharged. Two weeks later, he presented in the ED of our hospital with a nonproductive cough, fever, and chills. He had lost approximately 9 to 10 pounds in the past 3 to 4 weeks and had a decreased appetite. He continued to complain of joint pain not confined to one area. He denied significant shortness of breath and hemoptysis. His medical history was negative except for smoking one pack of cigarettes per day since being a teenager. He had no significant family history. He denied any allergies.
On physical examination, he was cachectic but in no acute respiratory distress. His lungs were clear except for a few rhonchi at the left lung base. The trachea was midline. There was no palpable adenopathy. The heart rate and rhythm were regular, and there were no rubs, murmurs, or gallops. He was neurologically intact. No swelling or redness was evident on the extremities, but there was clubbing of the fingers and toes. Bowel sounds were normal, and the abdomen was nontender and nondistended. There was no organomegaly.
What does the chest film show (see Figure 1)?