A 41-year-old man with fluorodeoxyglucose-avid thickening on PET scan.

A 41-year-old man was referred to the pulmonary clinic for symptoms of bilateral, sharp, pleuritic chest pain of several years' duration, slowly progressive exertional dyspnea over the past year, and an infrequent dry cough without hemoptysis. There was no history of pleural effusions or other significant respiratory disease. He complained of pain in multiple joints, including the lower back and shoulders. The patient had worked in the construction trade renovating old houses, including as a roofer for 3 years in the late 1980s. He was not aware of any specific exposure to asbestos. He was a current cigarette smoker with exposure quantified at 15 pack-years. His remaining medical history was significant for depression and obesity. His medications included fluoxetine, gabapentin, hydrocodone/acetaminophen, and trazodone.