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Progressive Dyspnea in an Appalachian Coal Miner

Case Editor - Judd Flesch

Reviewed By Environmental & Occupational Health Assembly

Submitted by

W. Alex Wade MD

Pulmonary Fellow

Section of Pulmonary and Critical Care Medicine , Department of Medicine

West Virginia University School of Medicine

Morgantown, WV

Jack L. Kinder, MD

Chair

West Virginia State Occupational Pneumoconiosis Board

Charleston, WV

Edward. L. Petsonk MD

Professor of Medicine

Section of Pulmonary and Critical Care Medicine, Department of Medicine

West Virginia University School of Medicine

Morgantown, WV

Submit your comments to the author(s).

History

A 32-year-old male initially presented in 1991 complaining of dyspnea on exertion and a non-productive morning cough for two years.  He was a lifelong nonsmoker and had worked for 15 years as an underground coal miner, transporting coal in a rubber-tired vehicle. Five years later, he sought reevaluation due to worsening dyspnea and productive cough. 

Physical Exam

His lungs were clear and the cardiovascular examination was normal.

Lab

The chest radiograph in 1991 was normal (Figure 1.1)

Five years after initial presentation, blood gases at rest on room air showed mild hypoxia (PaO2 73 mm Hg). 

The radiograph then demonstrated multiple bilateral small opacities, as shown in Figure 1.2. 

Figures


Figure 1.1

Figure 1.2

Question 1

What is the most likely diagnosis for this patient?


References

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