CTICasesSilicosis with Progressive Massive Fibrosis and Rounded Atelectasis
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Imaging findings
Baseline CT shows diffuse small nodules, hilar retraction, and confluent upper lobe masses representing progressive massive fibrosis (PMF), accompanied by classic eggshell calcification of mediastinal and hilar lymphadenopathy. A follow-up CT years later shows caudal retraction of the right upper lobe PMF mass, severe volume loss, and new peripheral pleural thickening with a whorled or swirling bronchovascular pattern, representing rounded atelectasis. PET/CT reveals intense hypermetabolism within the PMF mass and calcified lymph nodes, whereas the rounded atelectasis is non-FDG-avid, though the irregular, nodular pleural thickening shows moderate avidity suspicious for malignant mesothelioma.
Key takeaways
Silicosis is a classic pneumoconiosis characterized by upper lobe-predominant nodularity and PMF, often showing eggshell calcification of lymph nodes. Rounded atelectasis is a benign form of lung collapse associated with pleural thickening that can mimic a neoplasm; its benign nature is supported by the characteristic 'comet tail' sign and a lack of hypermetabolism on PET. However, in patients with shipyard work history and dual exposure to silica and asbestos, irregular pleural thickening must be carefully evaluated to exclude malignant mesothelioma.
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