CTICasesSilo Filler's Disease (Acute Nitrogen Dioxide Inhalation Lung Injury)
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Imaging findings
A farmer exposed to a brownish-red gas in a corn silo presented with acute shortness of breath. Initial chest radiograph showed a diffuse nodular pattern in the lungs. A subsequent CT scan revealed widespread ground-glass nodules, some with a complex "crazy paving" appearance, predominantly distributed in the upper lungs. Following treatment with steroids and Lasix, a radiograph two days later showed improvement.
Key takeaways
This is a classic presentation of acute silo filler's disease, an acute lung injury caused by the inhalation of nitrogen dioxide gas. The characteristic imaging features include diffuse nodular and ground-glass opacities, often with an upper lung predominance, reflecting the inhalational nature of the injury. Patients can later develop constrictive bronchiolitis as a long-term complication. The brownish-red color of the gas indicates its high toxicity.
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