Question 118

Question:

A 64 year-old shipbuilder arrives at your office complaining of six months of worsening exertional dyspnea. He is a lifelong non-smoker. A chest radiograph reveals pleural thickening. What other finding would be expected in this patient?

Correct Answer: D.  Ferruginous bodies on lung biopsy

The patient must have a history of asbestos exposure as evidenced by his occupational history and the pathognomonic finding of pleural plaques (thickening). The Ferruginous bodies found in his lungs are composed of asbestos fibers coated with iron and proteins. While not exclusive to this pneumoconiosis, they are frequently found on tissue biopsy. Asbestos exposure tends to cause an interstitial lung disease that is classically worse at the lung bases.
Although smoking frequently happens to be comorbid with asbestosis, the question stem clearly states that this patient has never smoked. Progressive cough, and a decreased FEV1/FVC ratio are hallmarks of COPD, but interestingly are unlikely to be found in isolated asbestosis. There is no reason to believe that this patient has active tuberculosis, so finding AFB would be rather unexpected.