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Progressive massive fibrosis

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Last revised by Rohit Sharma ◉ on 11 Jun 2024

Citation, DOI, disclosures and article data

Citation:

Weerakkody Y, Sharma R, Collins E, et al. Progressive massive fibrosis. Reference article, Radiopaedia.org (Accessed on 27 Mar 2025) https://doi.org/10.53347/rID-20929

DOI:

https://doi.org/10.53347/rID-20929

Permalink:

https://radiopaedia.org/articles/20929

rID:

20929

Article created:

22 Dec 2012, Yuranga Weerakkody ◉

Disclosures:

At the time the article was created Yuranga Weerakkody had no recorded disclosures.

View Yuranga Weerakkody's current disclosures

Last revised:

11 Jun 2024, Rohit Sharma ◉

Disclosures:

At the time the article was last revised Rohit Sharma had no financial relationships to ineligible companies to disclose.

View Rohit Sharma's current disclosures

Revisions:

37 times, by 18 contributors - see full revision history and disclosures

Systems:

Chest

Synonyms:

PMF
Progressive massive fibrosis (PMF)

Progressive massive fibrosis (PMF) refers to the formation of large mass-like conglomerates, predominantly in the upper pulmonary lobes, associated with radiating strands. These classically develop in the context of certain pneumoconioses (especially coal worker's pneumoconiosis and silicosis) although similar mass-like densities have occasionally been described with talcosis.

Radiographic features

Plain radiograph

May be seen as large symmetric bilateral opacities with irregular margins in the upper lobes ³.

CT

Mass-like areas of lung opacification associated with radiating strands are seen; the "sausage-shaped" mass is characteristic. These regions commonly contain air bronchograms and calcifications ⁴. These areas can shrink over time and migrate towards the hilar regions ⁵.

MRI

Magnetic resonance imaging can be helpful for distinguishing between progressive massive fibrosis and lung cancer ³. The latter typically appears T2 hyperintense, whereas progressive massive fibrosis appears T2 hypointense (compared to skeletal muscle) ³.

Lesions most frequently have the following signal characteristics ^1,2:

T1: iso- to hyperintense
T2
- hypointense (compared with skeletal muscle)
- areas of internal high T2 signal
T1 C+ (Gd): may show rim enhancement ⁸

Nuclear medicine

On PET-CT, progressive massive fibrosis can be FDG-avid ³.

Differential diagnosis

Possible differential considerations include:

pulmonary talc granulomatosis
sarcoidosis
lung cancer: has a higher SUVmax on PET-CT ⁷

In some situations consider pulmonary manifestations of sarcoidosis.

Quiz questions

References

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