Histology saves the day for a patient with sarcoidosis

Imaging suggests metastatic cancer in this patient with dry cough. At what point do you refer him to palliative care?

David, an 83-year-old retired businessman, presents with a three-month history of a dry cough that occasionally affects his sleep.

He denies any weight loss, haemoptysis or other associated symptoms.

David is enjoying his retirement, partakes in regular exercise and has a healthy diet.

He is planning to go on a cruise and hopes to get rid of the cough before his departure in three weeks. He is a non-smoker and occasional drinker.