CLINICAL INFORMATION

History of Present Illness

• 54-year-old Hispanic male with insidious onset of dyspnea on exertion over the last 3 years
• Recently the patient has noticed the onset of an associated dry cough
• No other constitutional symptoms
• Occupation: The patient worked as a farmer for 30 years in Mexico and the United States. No significant bird exposure
• Habits: 40 pack/year history of smoking. Stopped smoking 14 years ago

Past Medical History

• No other significant illnesses or surgeries in the past
• Allergies: none
• Medications: none
• Family history: no family history of lung disease
• Review of systems: noncontributory

Physical Exam

• Slender male in no distress on room air
• Vital signs stable with a respiratory rate of 18/min. No accessory muscle usage
• Chest exam significant for faint inspiratory crackles at the bases
• Remainder of examination is within normal limits

Chest X-Ray

• Bilateral mostly basilar interstitial infiltrates
• Relatively well-preserved lung volumes