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Asbestosis — SCE Respiratory MCQ

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HardILDAsbestosisSCE Respiratory

A retired lagger has a 25-year heavy asbestos exposure, basal subpleural fibrosis, traction bronchiectasis and calcified diaphragmatic pleural plaques. ANA and avian precipitins are negative. Which diagnosis best integrates exposure and imaging?

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Correct answer: E — Asbestosis with asbestos-related pleural disease

Explanation lettering: E = shown as A · C = shown as B · D = shown as C · B = shown as D · A = shown as E

A is correct. A credible dose-latency history plus basal fibrotic disease and pleural plaques strongly supports asbestosis. Plaques alone do not prove parenchymal asbestosis, but here the combined pattern is persuasive. IPF requires exclusion of occupational causation. Hypersensitivity pneumonitis and sarcoidosis favour different distributions and exposure features; RB-ILD is smoking-related and usually ground-glass/centrilobular rather than this pleural-fibrotic combination.

Reference: NICE CG163 idiopathic pulmonary fibrosis recommendations: https://www.nice.org.uk/guidance/cg163/chapter/Recommendations