Pulmonary Medicine Quiz

Prepared by Timothy J. Barreiro, DO, Assistant Professor of Internal Medicine, Division of Pulmonary and Critical Care, Northeastern Ohio Universities College of Medicine, St. Elizabeth Hospital,

Rootstown, Ohio; William Beckett, MD, Professor, Environmental Medicine and Medicine, and Philip J. Katzman

MD, Assistant Professor, Division of Pathology and Laboratory Medicine, Strong Memorial Hospital, University of

Rochester School of Medicine and Dentistry, Rochester, NY

A 74-year-old man presented with a 2-year history of gradually increasing dyspnea on exertion. Before retiring from his construction job, he worked with asbestos insulation for 36 years. His chest x-ray revealed bibasilar linear opacities and changes consistent with mild fibrosis (Figure 1). Pulmonary function test results were consistent with restrictive lung disease. Bronchoscopy with bronchoalveolar lavage (BAL) yielded negative cultures but revealed a positive finding that supports the diagnosis (Figure 2).

What's the Diagnosis?

• Usual interstitial pneumonitis (UIP)
• Langerhans cell histiocytosis
• Sarcoidosis
• Asbestosis

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