20th February 2025

A 62-year-old car mechanic is referred to the respiratory clinic by his GP.

A 62-year-old car mechanic is referred to the respiratory clinic by his GP. He complains of ongoing, progressive exertional dyspnoea for the last 3 years. He is usually fit and well and his only regular medication is tamsulosin. He had asthma as a child but tells you he “grew out of this”.

On examination, you note some fine end-inspiratory crackles in both bases. His ECG is unremarkable. He is awaiting an echocardiogram. His CXR is as follows:

What is the most likely diagnosis?

Select the SINGLE most appropriate option from the list below. Select ONE option only.