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SELF ASSESSMENT QUESTIONS
An unusual case of clinicoradiological dissociation
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  1. C Mahendran1,
  2. N B S Mani2,
  3. S Jogai3,
  4. A N Aggarwal1
  1. 1Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
  2. 2Department of Radiodiagnosis
  3. 3Department of Histopathology
  1. Correspondence to:
 Dr Aggarwal;
 anaggarwal{at}yahoo.com

http://dx.doi.org/10.1136/pmj.78.919.302-a

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    Answers on p 306.

    A 28 year old truck driver was seen at this institute with an abnormal chest radiograph (fig 1). He complained of non-specific chest pain for the past three years, and denied any other respiratory symptom. He had no significant occupational exposure to organic or mineral dust. His clinical examination was essentially normal. He had a respiratory rate of 20 breaths/min. Spirometry showed mild restrictive abnormality with vital capacity (VC) of 2.72 l (64.45% of predicted); forced expiratory volume in first second (FEV1) of 2.5 l (71.02% of predicted) and FEV1/VC ratio of 91.9%. Arterial blood gas analysis on room air showed normoxaemia with an arterial oxygen pressure of 12.3 kPa (92 mm Hg) with an oxygen saturation of 97%. Blood counts and biochemical tests for renal and hepatic functions were normal. Computed tomography of his chest is shown in fig 2.

    Figure 1
    Figure 1

    Chest radiograph of the patient.

    Figure 2
    Figure 2

    Computed tomogram of the chest.

    QUESTIONS

    1. What are the findings on the chest radiograph and computed tomogram of the chest?

    2. What is the likely diagnosis?

    3. What additional investigations should be performed to confirm the diagnosis?

    4. What is the treatment and prognosis of the condition?

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