A 65-year-old man worked in a shipyard for 10 years, and then he worked for 5 years for a company that installed fire retardant insulation. He experienced increasing dyspnea for 11 years with progressive respiratory failure and hypoxemia. A CT scan of his chest now shows a large mass encasing the left lung. Which of the following findings is most likely to be seen on a chest radiograph in this patient?
This patient has an occupational risk of asbestos exposure. The inhaled asbestos fibers become encrusted with iron and appear as the characteristic ferruginous bodies with iron stain. The firm, tan mass encasing the pleura is most likely a malignant mesothelioma. Asbestosis more commonly gives rise to pleural fibrosis and interstitial lung disease, similar to other pneumoconioses. This is seen grossly as a dense pleural plaque, which often is calcified. Asbestosis can give rise to bronchogenic carcinoma, especially in smokers. Fluffy infiltrates suggest an infectious process. Upper lobe cavitation suggests secondary tuberculosis. An endobronchial mass could be a carcinoid tumor, which is not related to asbestosis. The pleural mass likely leads to obliteration of the pleural space, with no effusion.
Bilateral fluffy perihilar infiltrates
Bilateral upper lobe cavitation
Diaphragmatic pleural calcified plaques
Endobronchial mass with atelectasis
Respiration