CTICasesSilicosis with Lung Cancer and Central Lobular Nodules
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Imaging findings
A patient with a history of silicosis from foundry work presented with a chest mass and SVC narrowing. CT with contrast shows marked narrowing of the SVC by a large mediastinal mass and lymph nodes, which was biopsied at an outside hospital and called silicosis. However, the mass is also invading the upper lobe pulmonary artery and showing enhancement, consistent with lung cancer. The pulmonary nodules characteristic of silicosis show an unusual central lobular distribution, with relative sparing along fissures, rather than the classic perilymphatic distribution. There is also a large conglomerate mass of complicated silicosis with patent airways.
Key takeaways
Silicosis is a pneumoconiosis with characteristic perilymphatic nodules and progressive massive fibrosis (PMF). However, some cases may exhibit an unusual central lobular distribution of nodules. Silicosis is a known carcinogen, increasing the risk of lung cancer; differentiating malignant transformation/superimposed cancer from complicated silicosis can be challenging, especially when a mass is found within a field of silicosis. Features like intense enhancement, SVC obstruction, and vascular invasion suggest malignancy.
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