000 Silicosis

In a Nutshell

  • Clinical Presentation
    • Distant history of silica exposure (sandblasting, glass manufacturing, mining), generally appears 10-30 years after exposure
    • Chronic, insidious cough and dyspnea on exertion
    • Crackles, wheezing, and rhonchi may be present on lung exam
  • Imaging Features
    • Size
      • Nodular opacities 1-10mm diameter,
      • well defined and uniform, may be calcified
    • Shape
      • subpleural nodules coalesce,
        • “candle wax” lesions or
        • “pseudoplaques”
    • Position
Position of Disease
Upper and mid lung field distribution
Ashley Davidoff MD TheCommonvein.net lungs-0772
      • Upper lobes and posterior lung field opacities
      • perilymphatic distribution
      • subpleural nodules
    • Associated Foindings
      • Hilar and mediastinal lymphadenopathy
      • Calcified lymph nodes: “eggshell calcifications”
  • Potential Complications
    • Progressive massive fibrosis
    • Increased risk of mycobacterial infections
    • Chronic necrotizing aspergillosis
    • Rheumatic disease: systemic sclerosis, rheumatoid arthritis
  • Remember
    • Acute silicosis (silicoproteinosis) is a slightly different pathology characterized by rapid development of cough, dyspnea, fatigue, and weight loss that can present a few weeks to years after high concentrations of silica exposure.

Reticulo-Nodular Pattern on CXR

Silicosis
CXR (PA view) shows interstitial reticulonodular and coalescing opacities in the lungs bilaterally consistent with a diagnosis of classic complicated silicosis. Differential diagnosis includes coal worker’s pneumoconiosis and talcosis.
Case courtesy of Dr Ian Bickle, Radiopaedia.org, rID: 33227

 

SILICOSIS
Chest X-ray showing uncomplicated silicosis
Courtesy Gumersindorego

 

Silicosis ILO Classification 2-2 R-R
Courtesy DrSHaber
SILICOSIS
Chest X-ray showing complicated silicosis
Courtesy Gumersindoreg

 

Massive Pulmonary Fibrosis

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

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.

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

Case from the Literature of Massive Pulmonary Fibrosis

Silicosis with Massive Pulmonary Fibrosis
Coronal CT at the level of bronchi shows soft-tissue masses with irregular borders and significant bullous disease in bilateral lungs consistent with a diagnosis of classic complicated silicosis. Differential diagnosis includes coal worker’s pneumoconiosis and talcosis.
Case courtesy of Dr Michael P Hartung, Radiopaedia.org, rID: 71691

References and Links

Wikipedia
Radiopaedia