Vignette: A 55-year-old man presents to the clinic with a 3-month history of progressive dyspnea on exertion and dry cough. He is a construction worker and has been exposed to asbestos for more than 30 years. On physical examination, he has bilateral basal crackles. Chest X-ray reveals bilateral interstitial infiltrates. Lung biopsy demonstrates interstitial fibrosis with asbestos bodies.
Question: What is the most likely diagnosis in this patient?
D) Chronic obstructive pulmonary disease (COPD)
E) Idiopathic pulmonary fibrosis
This patient's occupational history of asbestos exposure, clinical symptoms of dyspnea and dry cough, physical examination findings of bilateral basal crackles, and histological findings of interstitial fibrosis with asbestos bodies are characteristic of asbestosis. Asbestosis is a type of pneumoconiosis that results from inhalation of asbestos fibers. The fibers become lodged in the lung parenchyma, leading to inflammation and fibrosis. Over time, this can progress to respiratory failure. The disease typically presents several decades after the initial exposure to asbestos. Mesothelioma is also associated with asbestos exposure, but it typically presents with pleural effusion and chest pain, rather than interstitial disease. Silicosis is associated with silica dust exposure, not asbestos. COPD is primarily associated with smoking. Idiopathic pulmonary fibrosis would be considered if the patient did not have an occupational exposure to asbestos.