This is the ninth in a continuing series of Radiologic-Pathologic Correlation Conferences held at the State University of New York (SUNY) Health Science Center at Syracuse. Dr. Jack Westcott, Professor and Chairman of Radiology at the Hospital of St. Raphael, New Haven, CT, and Clinical Professor of Diagnostic Imaging, Yale University College of Medicine, is the guest radiologic consultant. Dr. David Panicek, Chief of the Abdominal Imaging Section at the SUNY Health Science Center at Syracuse, is the moderator. Dr. E. Mark Levinsohn is coordinator of the series. Dr. Panicek: A 31/2-year-old girl was admitted for evaluation of recurrent pneumonia and persistent cough that had begun when she was 3 years old. Over a 6-month period, she was hospitalized twice for bilateral pneumonia that responded to antibiotic therapy. In addition, she had a chronic, hacking, nonproductive cough; clear nasal discharge; and an intermittent erythematous rash. Her travel and environmental histories were unremarkable. The patient had had several episodes of otitis media and persistent middle ear effusions that resulted in delayed speech and language development. She was known to have a small, asymptomatic ventricular septal defect. Her family history included a cousin who died at the age of 8 years from respiratory disease. Physical examination showed the right tympanic membrane to be erythematous and immobile, with fluid behind the membrane. The lungs were clear to auscultation and percussion. A grade Il/VI systolic murmur at the left lower sternal border was consistent with the known ventricular septal defect. Mild digital clubbing was present without cyanosis. Laboratory findings included a WBC count of 30,100/mI, 73% due to polymorphonuclear leukocytes (some with Dohle bodies) and 4% to bands (normal values: 5000-1 5,000/mI; 21 %-63%; 0%-7%, respectively). The erythrocyte sedimentation rate was elevated. An arterial blood gas determination with the patient breathing room air showed Po2 61 mm Hg, Pco2 31 mm Hg, CO2 21 mmol/l, and 02 saturation 91% (normal values: 95-1 00 mm Hg, 35-40 mm Hg, 24-30 mmol/ I, 94%-i 00%, respectively). Dr. Westcott: Frontal and lateral radiographs of the chest (Figs. 1 A and 1 B) show diffuse bronchial wall thickening, scattered patchy infiltrates, and linear atelectasis bilaterally. The lungs are mildly hyperexpanded, consistent with obstructive airway disease. A radiograph of the chest taken 1 month later (Fig. 1 C) shows slightly more density in the lung bases, particularly on the left side. The apparent dilated bronchi within some of these infiltrates suggest bronchiectasis and diffuse chronic lung disease. Sinus radiographs were unremarkable. Normal adenoid and tonsilar tissue was evident on the lateral view, excluding those forms of congenital immunodeficiency syndromes, such as congenital hypogammaglobulinemia, that are characterized by a lack of lymphoid tissue [1-3].