A 22-year-old woman is admitted through the emergency department with an episode of severe upper gastrointestinal bleeding. The patient has a known history of cavernous transformation of the portal and splenic veins but has been non-compliant with propanolol treatment. The bleeding is controlled with a Minnesota tube and transfusion of 4 units of blood. Endoscopy and sclerotherapy of bleeding varices are performed. The patient is scheduled for a gastric devascularization procedure. The following is the admission chest x-ray.

Upon further questioning, the patient states that the pulmonary abnormality had been recognized 3 years earlier with her first episode of gastrointestinal bleeding. Before that time, she states that she exercised daily. Since then, she complains that she has been having worsening dyspnea on exertion and occasional bloodstreaked sputum. Computed tomography (CT) scans of the chest are recommended.