CTICasesComplicated Silicosis with Progressive Massive Fibrosis and Asbestos-Related Pleural Plaques
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Imaging findings
Chest radiographs show progression from diffuse, well-defined, upper-zone predominant 3-4 mm nodules (simple silicosis) to coalescence of nodules forming a large opacity, particularly in the left upper lobe, with associated volume loss in the upper lobes, upward hilar retraction, and emphysema in the lower lobes (complicated silicosis/progressive massive fibrosis). CT confirms perilymphatic distribution of pneumoconiotic nodules, pseudo-plaquing along pleural surfaces, and large, high-attenuation, calcified masses representing coalesced nodules. Hypertrophy of extrapleural fat and bilateral pleural plaques (consistent with asbestos exposure) are also noted.
Key takeaways
This case illustrates the progression from simple to complicated silicosis (progressive massive fibrosis) in a sandblaster and foundry worker. The classic findings include coalescing upper lobe nodules, volume loss, hilar retraction, and compensatory emphysema. Co-existing pleural plaques indicate additional asbestos exposure, common in foundry settings. Recognizing these patterns is crucial for occupational lung disease diagnosis.
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