A 68-year-old man, a retired fireman, has developed symptoms of lower respiratory chest infection,
which have left him with a hacking cough. His CXR is shown below:
What would you arrange next to establish the diagnosis?
A A trial of inhaled corticosteroids
B Full lung function tests
C Fibreoptic bronchoscopy
D High-resolution CT chest scan
E Echocardiogram
Answer:
C Fibreoptic bronchoscopy
Discussion: The CXR shows a rounded mass behind the heart that is highly suspicious of a lung cancer, bilateral calcified pleural plaques consistent with previous asbestos exposure, an enlarged heart and bilateral small pleural effusions. The risk of developing lung cancer amongst those who have been exposed to asbestos is significantly greater in smokers than in non-smokers.
The relative risk of lung cancer for cigarette smokers with a history of asbestos exposure is 59-fold,
compared with a 6-fold relative risk for non-smokers with a history of asbestos exposure. Cigarette
smoking without a history of asbestos exposure is associated with an 11-fold increase in the risk of lung cancer.
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