Ominous lung cavity “Tambourine sign”

Table 1 Confounding factors leading to delay in diagnosis in the index case

Young age of presentation

Lack of significant soft tissue component and thin walls initially

Multifocality favoured a systemic infection/disease (vasculitis) rather than primary lung malignancy

Increase in wall thickness in second CT was suspicious, but interpretation was confounded by heavy growth of streptococcus.

Waxing and waning symptoms.

Repeated negative BAL and FOB

CT: Computed tomography; BAL: Bronchoalveolar lavage; FOB: Fiberoptic bronchoscopy.