Week 9 Question 1:

Mr. G is a 74-year-old male with no significant past respiratory history except for “asthma” presented to the chest clinic for preoperative clearance for a cholecystectomy. He had a 7-year history of episodic cough productive of white to yellow phlegm, which cleared with antibiotics, but was recurring at more frequent intervals. The cough had been constant for several months at the time of presentation. He also complained of progressive dyspnea on exertion over the same period such that she could now walk only about 4 blocks. He does not smoke cigarettes. He is a retired builder and sandblasts classic cars in his garage as a hobby. Physical examination was remarkable for an increased second pulmonic sound and jugular venous distension. Lungs had rare rales and rhonchi. No clubbing was noted.

A CT of the upper lungs (B) in 3/98 shows multiple round and irregularly-shaped small nodules, many of which appear to be in a centrilobular/peribronchiolar distribution. A large, irregularly-shaped mass on the right appears to be a conglomerate of small nodules.

1. Discuss the differential diagnosis.

2. What is the most likely diagnosis?

3. Explain the pathophysiology.