case19

Background

A 57-year-old woman presents to her primary care physician with slowly progressive dyspnea, occasional productive cough, poor appetite, and weight loss of 18 pounds.
Her medical history is significant for chronic airflow limitation and hypothyroidism. Apart from decreased breath sounds over the right apex, the findings of her clinical examination are inconclusive.
Lung function is impaired, exhibiting a markedly reduced FEV1, FEV1/FVC ratio, and DLCO with moderately reduced FVC. Routine laboratory results show an elevated ESR of 73 mm/HR (0-23), slight lymphopenia, and slight thrombocytosis. The patient is referred for cross-sectional imaging studies to further evaluate her condition.
Initial contrast-enhanced computed tomographic (CT) studies (not shown) demonstrated marked right apical pleural based thickening without definite mass lesions or mediastinal or axillary lymphadenopathy. A CT-guided fine-needle aspiration biopsy of the right lung apex showed no evidence of malignancy or infection.
Four months later, a repeat contrast-enhanced chest CT study (not shown) demonstrated extensive bi-apical pleural thickening and extensive fibrotic change with multiple thick-walled cavities in both upper lobes with mild mediastinal and left axillary lymphadenopathy. One week later, the patient was referred for dual-modality positron emission tomography/ CT (PET-CT) with 2-deoxy-2[F-18]fluoro-D-glucose (FDG) to acquire additional information regarding her condition.

What is Diagnosis?

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