Chronic Silicosis with Progressive Massive Fibrosis
A 76-year-old man presented to the pulmonary clinic with a 6-month history of progressively worsening dyspnea and productive cough. The patient had never smoked; 40 years earlier, he had worked as a sandblaster for 7 years. Physical examination was notable for diminished breath sounds and diffuse inspiratory rhonchi. Findings on radiography (Panel A) and computed tomography (Panel B) of the chest included numerous calcified nodules, eggshell calcifications, and coalescence of apical opacities and larger lesions characteristic of progressive massive fibrosis with upper-lobe volume loss. A diagnosis of chronic silicosis with progressive massive fibrosis was made. Chronic silicosis may develop many years after the inhalation of respirable crystalline silica and is associated with a range of occupations, including mining, foundry work, cement and concrete production, sandblasting, masonry, and ceramic production. Nodules typically occur in the upper zones of the lung. There are no specific therapies for chronic silicosis, except for avoidance of silica in the environment. During 3 years of follow-up, the patient had progression of dyspnea with decreasing exercise tolerance.
