A 40 year old man presented with repeated episodes of bronchospasm and hemoptysis. Chest X-ray revealed perihilar bronchiectasis. The most likely diagnosis is :
Sarcoidosis
Idiopathic pulmonary fibrosis
Extrinsic allergic alveolitis
Bronchopulmonary aspergillosis
Answer is D (Bronchopulmonary Aspergillosis): Coexistence of repeated of bronchospasm (asthma), Central (perihilar) bronchiectasis and haemoptysis suggest a diagnosis of allergic bronchopuhnonary aspergillosis. The questions gives us three leads: bronchospasm, hemoptysis, bronchiectasis. Presence of repeated episodes of bronchospasm indicates towards a possible existence of asthma. Hemoptysis, central bronchiectasis are well known complications of Allergic Broncho Pulmonary Aspergillosis. All three of these features are consistent with the diagnosis of ABPA.