A 68-year-<>ld handyman is admitted to the Emergency Department having fallen off a ladder whilst cleaning windows. After complaining of pain over his thoracic spine, he undergoes a chest x-ray which reveals ev1dence of pleural plaques. He is a non-smoker and complains of no respiratory symptoms. Walking up to 5 miles per day.
Which of the following is the most appropriate next step?
A Bronchoscopy and biopsy
B CT thorax
D Pulmonary function testing
E Trial of corticosteroids
Explanation ~ T’ ’ . rs No 11ft’fVention requ ·ed Although pleural plaques indicate prev1ous exposure to asbestos. gu1dance from the British Thoracic Society (BTS), ind•cates that in the absence of other chest disease, further investigation is not indicated and may indeed be harmful. As such th1s patient should be discharged without further intervention.
Bronchoscopy and biopsy, (Option A), is incorrect. This would only be indicated for potential malignancy or to aid diagnosis of fibrotic lung disease.
CT thorax, (Option B), is incorrect. CT thorax is an opuon for evaluation of focal abnormalities on the x-ray or changes consistent with pulmonary f1brosis.
Pulmonary function testing, {Option D), is Incorrect There are no symptoms indicating a need for pulmonary function testing.
Trial of corticosteroids, {Option E), is incorrect. A trial of corticosteroids may be considered for pulmonary f1brosis, not a consideration here