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Weekly Chest CasesArchive of Old Cases

Case No : 660 Date 2010-06-23

  • Courtesy of Chary Duraikannu, Kishore LT / CARE Hospitals, Hyderabad, India.
  • Age/Sex 50 / M
  • Chief ComplaintCough and dyspnea Working at iron ore industry
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6
  • Figure 7
  • Figure 8
  • Figure 9
  • Figure 10

Diagnosis With Brief Discussion

Diagnosis
Progresssive massive fibrosis
Radiologic Findings
Fig 1: chest radiograph PA view shows large masses in left upper and lower lobe with hilar enlargement.
Fig 2-6: Lung window setting of CT chest shows two large masses in association with pleura and surrounding spiculation noted in left upper and lower lobe.In addition few spiculated nodules noted in left upper and right lower lobe.
Fig 7-8: Mediastinal window settings of NECT chest shows multiple mediastinal and hilar nodes with faint calcification.
Fig 9-10: CECT shows mild enhancement of lung masses with no necrosis.
Video assisted thoracoscopy showed black hard lesion in left upper and lower lobe.

HPE :
- Left lower lobe mass showed necrosis with focal chronic inflammation and illdefined granuloma.
- Left upper lobe mass showed hyalinised nodule.
Brief Review
Silicosis and coal worker's pneumoconiosis result from inhalation of different inorganic dusts and have different histology. However,their radiological and HRCT appearances are quite similar.
There are two manifestations of silicosis and CWP - simple or uncomplicated and complicated type. The unique manifestation of acute exposure to large amounts of silica is termed silicoproteinosis.
The presence of large opacities (>1cm),also known as conglomerate mass or progressive massive fibrosis, indicates presence of complicated silicosis or CWP. In patients with silicosis, these masses represent a conglomeration of silicotic nodules associated with dense fibrous tissue; in CWP, they consist of amorphous black mass surrounded by some fibrous tissue. The masses can undergo necrosis and cavitation.
On plain radiograph these masses are first seen in midportion or periphery of upper lung zones and migrate towards hila with time leaving emphysematous changes between them and pleural surface. On CT, conglomerate masses are usually seen to be associated with a background of small nodules. They are usually oval and often have irregular borders. Apical scarring and adjacent bulla may be seen. Calcification, cavitation or necrosis can be seen in the conglomerate masses.
Complicated form of silicosis has a poor prognosis than simple silicosis, but this is not necessarily the case with CWP.
References
1. W.Richard Webb,MD, Charles B Higgins,MD.Thoracic Imaging ?Pulmonary and cardiovascular radiology.1st ed.Lippincott Williams and Wilkins;2004.chapter 18, Pneumoconiosis; p.482-485.
Keywords
Lung, Interstitial lung disease, Occupational lung disease, ILD,

No. of Applicants : 89

▶ Correct Answer : 66/89,  74.2%
  • - Uzunkopru Devlet Hastanesi , Turkey Armagan Sarac
  • - Teleradiology solutions , India harish bhambore
  • - CHUV , Switzerland ANNE-SOPHIE KNOEPFLI
  • - Hopital de Pau , France Mathieu Cannella
  • - Hangang sacred heart hospital , Korea (South) You Mie Han
  • - SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
  • - kyungpook national university hospital , Korea (South) jiwon park
  • - EKH-Berlin , Germany Michael Weber
  • - Inha University Hospital , Korea (South) Ju Won Lee
  • - NTUH , Taiwan Kuei-pin Chung
  • - Doctors Hospital , Bahamas muneesh sharma
  • - Montreal Chest Institute , Canada Faiz Kham
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - NDMVP Nashik , India Imran Jindani
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - CHU NANCY , France, Metropolitan GREGORY LESANNE
  • - Osaka University , Japan Osamu Honda
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - HOSPITAL MOINHOS DE VENTO porto alegre , Brazil ana zanardo
  • - EWHA WOMANS MOKDONG UNIVERSITY HOSPITAL , Korea (South) Sang Min Lee
  • - CHRU lille , France manuel toledano
  • - bmcri , India sanjeev choudri
  • - Fukuyama daiichi Hospital , Japan Mototsugu Saeki
  • - jiangsu province hospital , China yuan doctor
  • - Goa Medical College , India Paresh Desai
  • - Hospital M de Deus , Brazil Thiago Bento da Silva
  • - Yonsei university Shinchon Severance hospital , Korea (South) Na-young Shin
  • - CHU Nancy , France, Metropolitan Guillaume LUX
  • - Univ. of Miami/Jackson Memorial , United States mantosh rattan
  • - royal melbourne hospital , Australia kimchi kings
  • - mediciti hospitals , India paramjyothi gongati
  • - aarthi scans , India abirami mahadevan
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - McGill University , Canada Sean Carr
  • - Catholic medical center , Korea (South) HyunA Kim
  • - Osaka University , Japan Hiromitsu Sumikawa
  • - Youngdong Hospital , Korea (South) Sang Min Lee
  • - Seoul Nationial University Bundang Hospital , Korea (South) Hee Seok Choi
  • - Cairo University , Egypt Mamdouh Eissa
  • - OSWAL CANCER HOSP. , India VISHAL GARG
  • - Assam Medical college , India samudra borah
  • - IRSA Rochefort , France Viviane Pages
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Severance Hospital , Korea (South) Kyung-eun Kim
  • - Vital Imaging Centre, Mumbai,India , India Ganesh Agrawal
  • - Onomichi municipal hospital , Japan Ryotaro Kishi
  • - sunder lal jain hospital , India sanjeev vachher
  • - Beaulieu clinic Geneva , Switzerland gilles GENIN
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Aba Prefecture People Hospital竊ŒSichuan Maerkang竊Œchina , China pu peng
  • - All India Institute of medical sciences , India Justin Moses
  • - Hotel-Dieu Montreal , Canada nicolas gautier
  • - NASA SCANS new delhi , India RAKESH BHATIA
  • - Hospital Sotiria, Athens, Greece , Greece Vasilios Tzilas
  • - UZ GASTHUISBERG , Belgium Johan COOLEN
  • - Chonnam university hospital , Korea (South) Minyoung Jung
  • - CNUH , Korea (South) Seoin Jeong
  • - chonnam national university , Korea (South) Byung Hyun Baek
  • - chonnam national university hospital , Korea (South) Park yeon
  • - PITTWATER RADIOLOGY , Australia Julie Arora
  • - PITTWATER RADIOLOGY , Australia Saurabh Khandelwal
  • - Bundang CHA hospital , Korea (South) Jung Jin Young
  • - CNUH , Korea (South) Hyedoo Jung
  • - Asan Medial center , Korea (South) Chae Lim
  • - Chonnam National University , Korea (South) se hee Jung
▶ Correct Answer as Differential Diagnosis : 13/89,  14.6%
  • - Virgin Mary Hospital Burgas , Bulgaria VLADISLAV RUSINOV
  • - University of British Columbia , Canada Amr Ajlan
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - Song-do Hospital , Korea (South) Ji-young Yun
  • - , Korea (South) Hun-cheol lim
  • - GOLD child and chest clinic tirunelvelli , India saravanan m
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - All India Institute of Medical Sciences , India Jitesh Ahuja
  • - KING KHALID UNIVERSITY HOSPITAL , Saudi Arabia Elbagir Nasser
  • - PingTung Christian Hospital ,China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - Ondokuz Mayis University , Turkey Cetin Celenk
  • - radiologist, aditya imaging centre , India vivek patel
  • - Toyama University Hospital, Laboratory of Pathology , Japan TOMONORI TANAKA
▶ Semi-Correct Answer : 1/89,  1.1%
  • - Soonchunhyang university hospital, Bucheon , Korea (South) Hyelin Kim
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