Presentation
Routine pre-operative chest radiograph prior to surgery for urethral stenosis. 50 year smoking history.
Patient Data
Age: 75 years
Gender: Male
From the case:
Silicosis (with egg shell calcification)
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Frontal:
Ill-defined bilateral hila with multiple calcified adenopathies in it and in the retrocardiac space. Right costophrenic angle blunting. Aortic arch elongated and calcified.
Lateral:
We can easily appreciate the "eggshell" calcification of multiple adenopathies along the mediastinum and bilateral pulmonary hila.
Case Discussion
Main causes of lymph node calcification:
- benign
- tuberculosis
- histoplasmosis
- sarcoidosis
- silicosis
- coal worker's pneumoconiosis
- amyloidosis
- malignant
- treated lymphoma and metastases
Aids to differentiating cause: silicosis vs sarcoidosis vs tuberculosis
- calcified lymph nodes in tuberculosis tend to affect the mediastinum asymmetrically and unilaterally
- diffuse bilateral lymph node involvement is more common in sarcoidosis
- silicosis: the patient usually has a history of a silica-exposure related job (as in this case)