A 77‐year‐old never‐smoker presented with an abnormal screening chest x‐ray. He was still working, having been employed in coal mining for more than 40 years. He had spent more than 30 years working on the coal face and had also worked on roof bolting, in mine development and on ventilation support. Recently, he had worked as a coal mines inspector, a job for which he had been chosen because of his broad experience. He had undergone periodic medical examinations during all his employment without a previously abnormal result. The patient’s last chest x‐ray had been 4 years before his diagnosis. Although results had been reported as normal at the time, review of this image had later shown early lower zone interstitial changes (International Labour Organization category 0/1), and the recent chest x‐ray showed category 1/1 changes (subtle abnormalities).
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