216 The Korean Journal of Internal Medicine : Vol. 22, No. 3, September 2007 Figure 1. Chest radiograph shows increased haziness at the left lower lung field with obliteration of the cardiac border; this indicates a lobar pneumonia at the lingular division of the upper lobe and bilateral enlargement of the suprahilar area with a prominent left hilum. prior to admission, the patient presented with a cough that produced sputum and a three-day history of fever. On admission, the physical examination showed inspiratory crackles at the left lower lung field on chest auscultation. The patient was not febrile or tachypneic. The chest radiograph demonstrated an increased opacity, with obliteration of the cardiac border at the lower left lobe of the lung and bilateral hilar enlargement (Figure 1). In addition, the computed tomography (CT) scan of the chest demonstrated irregular bronchial narrowing and consolidation at the lingular segment of the left upper lobe, and also showed bilateral hilar and subcarinal lymphadenopathy (Figure 2). Bronchoscopic examina- tion revealed a polypoid mass-like lesion of approximately 1 cm Figure 3. Bronchoscopic examination shows a polypoid smooth- surfaced mass lesion that completely occluded the lingular division of the left upper lobe bronchus. in diameter that was occluding the lingular division of the left upper lobe of the lung (Figure 3). Biopsy of the lesions revealed granulomatous inflammation with epitheloid cells without caseation necrosis (Figure 4). Bronchial washing fluid showed small numbers of acid-fast bacilli (AFB) on Ziehl-Neelsen staining (Figure 4). The patient was treated with isoniazid, rifampicin, ethambutol, and pyrazinamide following the diagnosis of endobronchial tuberculosis. His respiratory symptoms were improved and the chest radiograph showed a slightly improved state in the left lung field after the initiation of treatment. After two months of treatment with anti-tuberculosis medication, M. avium was Figure 2. Chest CT scan shows irregular bronchial narrowing with consolidation in the lingular division of the left upper lobe. Small pleural effusion and hilar lymphadenopathy are also noted.