Summary

A 59-year-old man presented with a 4-year history of productive cough, shortness of breath and wheeze. He had been treated for asthma and given several courses of antibiotics which improved his symptoms. Medical history was unremarkable. There was no history respiratory disease in childhood although he was prone to chest infections in adult life. A high-resolution chest CT showed marked proximal cystic bronchiectasis associated with collapse of distal bronchi on expiration. A diagnosis of cystic bronchiectasis due to undiagnosed adult Williams-Campbell syndrome was made on the basis of these characteristic radiological features and the exclusion of other possible causes.