Clinical presentation:
58 year old man, smoker, with a 20 year history of chronic productive cough. Elevated haemoglobin level.

The lungs are large volume. The diaphragm appears low and flat. There are bullae in both lowerlobes. The proiximal hilar vessels arelarge, but taper rapidly. The heart is enlarged, relative to the large volume lungs. There is a bulge in the region of the main pumonary artery. There is no indication of pulmonary oedema in the current view.