Pulmonary Question 48

A 72-year-old man is evaluated for a 2-year history of cough and a 1-year history of increasing dyspnea. He describes the cough as nonproductive, and his shortness of breath is worse with exertion. He does not have chest pain, orthopnea, paroxysmal nocturnal dyspnea, or any other symptoms. Medical history is otherwise unremarkable. He has a 15-pack-year smoking history but quit 40 years ago. He worked as a construction worker for 40 years. He takes no medications.

On physical examination, temperature, blood pressure, and pulse rate are normal; respiration rate is 18/min. Oxygen saturation breathing ambient air is 96%. BMI is 24. Pulmonary examination reveals inspiratory crackles at the bases bilaterally. Cardiac examination is normal. The remainder of the physical examination is unremarkable.

Chest radiograph shows increased interstitial markings at the bases; calcified parietal pleural plaques are noted bilaterally. High-resolution CT shows bilateral peripheral- and basal-predominant septal line thickening with evidence of honeycomb change at the bases. Pulmonary function tests reveal an FEV1of 70% of predicted, an FVC of 75% of predicted, an FEV1/FVC ratio of 85%, and a DLCO of 65% of predicted.

Which of the following is the most likely diagnosis?

A  Asbestosis

B  COPD

C  Hypersensitivity pneumonitis

D  Idiopathic pulmonary fibrosis

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