title: Picture quiz.
abstract: A 38 year old male presented with worsening breathlessness and cough for 6 months duration. He was treated in the community with salbutamol and steroid inhaler by GP for suspected asthma but with no benefit. He presented to the emergency department complaining of further worsening breathlessness. His initial ECG (Figure 1) was abnormal. Subsequent CT scan of the chest was arranged (Figure 2, 3).