Figure1. Chest X-ray on initial presentation showed bilateral diffuse airspace opacity and patchy consolidative changes at both lung parenchyma.

Initial management included transfusion to two units of packed red blood cells, starting antibiotics to cover the possibility of community acquired pneumonia while the admission process was initiated.

Ultrasound scan of both kidneys showed normal size and no evidence of obstruction. The next day, the patient laboratory tests showed no improvement in his renal parameters, and he started to feel more shortness of breath. Computed tomography (CT) scan of the chest was done (figure 2), followed by bed Bedside bronchoscopy, and the presence of pulmonary hemorrhage was confirmed.