The CXR shows bilateral infiltrates and calcified nodules in both upper lobes. Differential diagnoses of upper lobe infiltrates include silicosis, tuberculosis, and ankylosing spondylitis. There is also egg-shell calcification of the hilar lymph nodes. The egg-shell calcification plus the upper lobe nodules are typical of silicosis. Differential diagnoses of egg-shell calcification include sarcoidosis, Hodgkin's lymphoma following radiotherapy, and coal-worker's pneumoconiosis.
CASE 10 SILICOSIS WITH PROGRESSIVE MASSIVE FIBROSIS (PMF)
This patient's CXR shows a right pneumothorax. In addition, there are bilateral diffuse nodules (<10 mm but >2 mm) which could be due to metastatic adenocar-cinoma, silicosis, disseminated histoplasmosis, or varicella infection. In silicosis, some nodules may coalesce to form conglomerate masses in the upper lobes called progressive massive fibrosis. Patients with silicosis are predisposed to pulmonary tuberculosis and serial CXR comparison is useful.
Case 11. This 40-year-old male of African origin was asymptomatic and had a routine CXR (Fig. 11.1). What is the likely diagnosis?
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