Elderly man with significant smoking history and occupational history of being a coal miner who presents with clubbing and hypoxia with bilateral upper lobe masses and areas of consolidation on chest x-ray most consistent with COPD and/or coal workersโ pneumoconiosis
Key idea: Of the common pneumoconioses, the majority affect the upper lobes (silicosis, coal workersโ lung, berylliosis) except for asbestosis (lower-lobe predominant)
Tuberculosis can also lead to upper lobe opacities, but it would more commonly lead to acute fever, night sweats and weight loss in a patient with exposure
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