A 42 year old man presents with exertional dyspnea for 10 years, which rapidly progressed over the last 7 months to the point that it is now present even at rest. He also experienced a nonproductive cough and generalized weakness during the same time. His medical history is unremarkable, he is not on any drugs, and he does not smoke. He worked as a stonecutter for a 10 year period, until 7 years ago. His full blood count is normal, but the ESR is 45mm in the 1st hour.
The tuberculin test is negative
There are mottled opacities and large nodular masses in both lungs, with the right upper and mid zones particularly affected.
There are bilateral fibrotic masses, with pulmonary thickening. The fibrosis is predominantly in the upper and mid zones; the nodules are larger on the right side.
The lung function tests demonstrate a mixed obstructive and restrictive pattern.