116Lu Silicosis and Massive Pulmonary Fibrosis

Maegan Lu, MS4

Jonathan Scalera, MD

65 year-old male with known history of COPD on nocturnal O2, pulmonary HTN, and past occupation in marble quarry presents to ED with 5 days of cough and dyspnea.

In ED, patient HR 131 and RR 28 with O2 sat in 80s on RA. VBG shows  pH 7.38 and pCO2 55 mmHg

CXR (PA view) shows significant linear and reticular interstitial thickening (red arrow) in bilateral lungs. Several large bullae (blue arrow) scattered bilaterally, most notably in the RML. Increased opacity in left upper perihilar region (green arrow) consistent with a diagnosis of silicosis, complicated by progressive massive fibrosis. Differential diagnosis includes other ILDs, atelectasis, or pneumonia.
Courtesy Maegan Lu, Jonathan Scalera, MD
CT chest without contrast in the coronal projection at the level of the hilum shows eggshell calcifications in the hilar and mediastinal lymph nodes (red arrow) consistent with a diagnosis of silicosis, complicated by progressive massive fibrosis. Bullous disease (blue arrow) is also seen bilaterally, right greater than left. Differential diagnosis includes coal-worker’s pneumoconiosis, sarcoidosis, and blastomycosis.
Courtesy Maegan Lu, Jonathan Scalera, MD
CT chest without contrast in the axial projection at the level of the ascending aorta shows eggshell calcifications in the hilar and mediastinal lymph nodes (red arrow) consistent with a diagnosis of silicosis, complicated by progressive massive fibrosis. Bullous disease (blue arrow) is also seen bilaterally, right greater than left. Differential diagnosis includes coal-worker’s pneumoconiosis, sarcoidosis, and blastomycosis.
Courtesy Maegan Lu, Jonathan Scalera, MD

Clinical Follow Up

Following BiPAP placement in the MICU, patient’s respiratory status showed marked improvement. Final diagnosis was acute COPD exacerbation in the setting of underlying silicosis with progressive massive fibrosis.

Patient was treated with albuterol, ipratropium, and prednisone for COPD exacerbation. Patient was progressively weaned to RA while maintaining O2 sat >95% through day of discharge.