CTICasesSilicosis with Early Pseudoplaque and Eggshell Nodal Calcification
[...]. Silicosis with Early Pseudoplaque and Eggshell Nodal Calcification. CTICases. Published September 19, 2026. https://cticases.com/c/hva2u
Imaging findings
A smoker with an occupational history had subtle upper lobe abnormalities on the radiograph. CT showed small nodules and calcifications in the lungs, some peripheral and subpleural, a few of them calcified, with emphysema. In the upper lobes, particularly the right, the peripheral nodules were beginning to coalesce into early pseudoplaques. Comparison of a 2018 CT with a 2026 CT showed progression, with more confluence on maximum intensity projection images, which made the small nodules more conspicuous. The mediastinal and hilar lymph nodes showed peripheral eggshell calcification. He had exposure to silica, asbestos, mining and beryllium, as well as a history of keeping birds.
Key takeaways
A pseudoplaque is a subpleural aggregation of small nodules that coalesce into a plaque-like band and often calcify, and it is characteristic of silicosis and coal worker's pneumoconiosis rather than true asbestos-related pleural plaque. Maximum intensity projection images help identify small nodules and track progression. Eggshell calcification of lymph nodes narrows the differential to silicosis, coal dust exposure and sarcoidosis, although not every node needs to show it. Workers often have many overlapping exposures, so the occupational history should be taken broadly.
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