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A 50-year-old man consults a physician because he has developed a chronic, non-productive cough and is experiencing a reduced ability to
do strenuous work. His symptoms have developed insidiously. On questioning, he states that he is a smoker and has also worked as a
contractor for all of his adult life. Physical examination is notable for the presence of repetitive end-inspiratory basal crackles and finger
clubbing. A chest x-ray film shows diffusely distributed, small irregular opacities that are most prominent in the lower lung zones. Localized
areas of pleural thickening are also noted. No large masses are seen.
The chest x-ray film is most consistent with which of the following?
A. Emphysema
B. Interstitial disease
C. Lobar pneumonia
D. Lung cancer
E. PIeural effusion
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Nope wrong calmer try again
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ok here u go ... 
The correct answer is B. Diffusely distributed small irregular opacities suggest the presence of interstitial lung disease.
Emphysema (choice A) would produce unusually dark lung fields.
Lobar pneumonia (choice C) would produce a "white out" of one or more lung lobes.
Lung cancer (choice D), if large, would produce a mass lesion (often involving a bronchus), or, if very small, might not be recognized on chest x-ray.
Pleural effusion (choice E) would cause a whitened area due to fluid below the lung
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hi nickmle,
Why this pt is having pleural thickening, could u please explain this.
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yes interstitial disease... non productive cough... usually lower lobes involved... pleural thickening is present in localised areas...most probably reactionary
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i think its becoz of inflamm process ..tht we see pleural thickening
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hey sharky this is wht i found...
Pleural thickening may follow organization of a variety of inflammatory processes involving the pleura. These include infective pleural effusions, empyema, haemothorax, occupational exposure to asbestos or talc (see asbestosis, talcosis), rheumatoid lung disease, radiation therapy and drugs.
Pleural thickening may also occur as a result of infiltration of the pleura by various malignant tumours, especially mesothelioma and metastatic adenocarcinoma. It may be uni- or bilateral, diffuse or localized and may be calcified.
On the chest radiograph the changes predominantly affect the dependent areas with blunting of the costophrenic angle.
Extensive pleural thickening produces volume loss and a veil-like reduction in transradiancy of the hemithorax. There is a soft tissue density medial to and paralleling the chest wall with a well-defined inner margin. There may be extension into the fissures which appear thickened. In contradistinction to pleural fluid the appearance remains constant on a decubitus radiograph.
Hope this helps..
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Thanks a lot nickmle.
goodluck
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