Presentation
No past medical history presented with progressively worsening dyspnea on exertion and dry cough for 2 months. Working as a granite cutter for 30 years.
Patient Data
- Innumerable reticulonodular opacities mainly in the upper and mid lung zones with patchy consolidative and coalescent pleural and fissural based dense airspace opacifications are concerning for silicosis/pneumoconiosis in this patient with history of occupational exposure. Clinical and laboratory correlation is suggested.
- No discrete cavitary disease to suggest an acute infectious atypical infection.
- No discrete pleural effusion or pneumothorax.
Innumerable confluent densities and nodularities with a symmetric upper lobe predominance and perilymphatic distribution. Mosaic attenuation is seen at the lung bases without any pleural effusions. These findings are consistent with silicosis.
Case Discussion
Silicosis is a type of pneumoconiosis where silicon dioxide is deposited in the airways, causing directly toxic effects on the lung parenchyma and also activating macrophages and the inflammatory cascades which is thought to exacerbate the damage. Occupational exposure to sandstone, quartz, or granite is the most critical risk factor for the development of silicosis. Acute forms of the disease can occur, but an insidious, chronic course is common, as in the present case. There are currently no specific therapies for silicosis and best treatment is only removal of the source of exposure; as with other occupational exposure lung disease, lung transplant can be considered.
This case was submitted with supervision and input from:
Soni C Chawla, M.D.
Health Sciences Clinical Professor,
Department of Radiological Sciences,
David Geffen School of Medicine at UCLA.
Attending Radiologist,
Olive View - UCLA Medical Center.