Definition

Epidemiology

Mainly existing cases; occupational safety regulations have greatly reduced the incidence of new cases Chronic inhalation of inorganic dusts (especially silicate in crystalline form) Long-term exposure (sand blasters, quarry workers, miners).

Etiology, pathophysiology, pathogenesis

Alveolar phagocytosis and interstitial deposition of inhaled particles Development of interstitial reticulonodular granulomas of varying severity up to and including massive fibrosis. This leads to parenchymal shrinkage and scarring with emphysema.

Imaging Signs

Modality of choice

Radiographs, CT.

Radiographic findings

Sharply demarcated, focal nodular lesions (1–10 mm in diameter) in the upper and middle lung fields, often with calcifications These may become confluent, forming massive conglomerates Hilar and mediastinal lymph nodes show eggshell calcification.

CT findings

Micronodular lesions in the center and at the periphery of a lobule within the upper and middle lung fields Signs of pulmonary fibrosis.

Fig. 3.1 Anthracosilicosis in a 64-year-old man. Sharply demarcated, relatively dense, and partially confluent focal nodular lesions disseminated over both lungs, and increasing from base to apex. Bilateral apicolateral pleural calluses. Perihilar shadowing.

Fig. 3.2 Anthracosilicosis in a 60-year-old man. The plain chest radiograph (a) and axial CT scans (c, d) show sharply demarcated nodules and large scarred focal lesions (conglomerates) in the upper lung fields, accompanied by shortening of the hila. CT also demonstrates bullous formations. The enlarged, severely calcified hilar and mediastinal lymph nodes, some exhibiting eggshell calcification, are best visualized on the coronal MIP (b).

Symmetric micronodular changes in the upper and middle lung fields Calluses.

Clinical Aspects

Typical presentation

Dyspnea at rest and during exercise Cough Cyanosis Progressive fibrosis can lead to right heart failure.

Therapeutic options