An unusual cause of breathlessness: part 1
A71 year old man with breathlessness and a non-productive cough was referred by his general practitioner to the respiratory team. He gave a two year history of breathlessness, and at presentation had an exercise tolerance of about 180 metres. He denied wheeze, slept with four pillows, and occasionally woke with shortness of breath. He was not taking any regular medication, and was unaware of any drug allergies. He had no relevant family history. Thirty years previously, benign asbestos related disease had been diagnosed. The patient had worked in the postal industry all his life, had never smoked, and consumed 10 units of alcohol a week.
Examination showed the man was of normal build and comfortable at rest. Basic observations were within normal limits. Physical examination was unremarkable with no evidence of cardiovascular or respiratory disease. Results of spirometry were within normal limits. A chest radiograph revealed subtle pleural thickening (characterised