CTICasesSilicosis in a Hanford Site Construction Worker
[...]. Silicosis in a Hanford Site Construction Worker. CTICases. Published September 19, 2026. https://cticases.com/c/fxkcy
Imaging findings
Without a true chest radiograph, the CT localizer showed upper lobe abnormality with nodules, some very dense. CT showed upward and anterior retraction of the upper lung structures with tracheal deviation, numerous small nodules including nodules along the fissures, emphysema, and extensive calcification of the nodules and lymph nodes. A single calcified granuloma was present in the spleen. The patient was a carpenter who had worked on cleanup at the Hanford site with exposure to concrete dust during demolition, as well as other exposures including possible beryllium.
Key takeaways
Upper lobe predominant nodules with volume loss, fissural nodules and heavy calcification in a construction worker favor silicosis, with sarcoidosis and chronic beryllium disease as the main differential considerations. The degree of calcification seen here would be unusual for sarcoidosis and berylliosis. Silica is the most harmful of these dusts, and the recent rise and earlier onset of coal worker's pneumoconiosis is attributed to mining methods that cut through surrounding rock and increase silica exposure. A single calcified splenic granuloma suggests incidental prior histoplasmosis. Occupational lung disease diagnoses are often not unambiguous because workers have multiple exposures.
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