cxr: silico-tuberculosis
TRANSCRIPT
IMAGE OF THE WEEK
CASE A 52 yr old female patient came with
COMPLAINTS:BreathlessnessDry cough on & off for past 6 months
HISTORY:Had similar episode before 3 years, treated
in stanley – lost recordsH/O sputum positive PTB treated with ATT 3
years backH/O pott’s spine treated 2 years back
Occuptional history:Working in sand filtration segment in brick
production unit.
On examination:GC good poorly built & nourishedgeneralised pigmentation all over body more significant in faceCVS- s1,s2 +RS – blt wheeze +
PLAIN X RAY
X RAY FINDINGS Plain x ray chest PA view Centrally placed Penetration adequte Rotated to left Bony structures appear normal Trachea in midline Bilateral lung parenchymal radio-opaque lesions
seen Bilateral hilar nodes show well rounded radio-
opaque shadow.(calcifications) Bronchectatic chages in Rt lower lobe
UPPER / MIDDLE LOBE SECTIONS
LOWER LOBE SECTIONS
IMPRESSION
DIGITAL X RAY
DD FOR BILATERAL HILAR CALCIFICATIONS
Sarcoidosis Silicosis Post irradiation of hodgkins lymphoma Blastomycosis Sleroderma Histoplasmosis Amyloidosis
EGG SHELL CALCIFICATIONRADIOLOGICAL CRITERIA
Shell-like calcifications up to 2 mm thick must be present in the peripheral zone of at least two lymph nodes.
The calcifications may be solid or broken. In at least one of the lymph nodes the ringlike shadow must
be complete. The central part of the lymph node may show additional
calcifications. One of the affected lymph nodes must be at least 1 cm in its
greatest diameter
SLATE GREY PIGMENTATION
FINAL DIAGNOSIS
OCCUPATIONAL LUNG DISEASE SILICOSIS
Chronic complicated type- silicotuberculosis
EXPOSURE TO SILVER COMPOUNDS
SILICOSIS
Inhalation of crystalline silica TYPES:
Chronic – >10 yrs , eggshell calc.Accelerated – 5-10 yrs , PMFAcute – silicoproteinosis - hypersensitivityComplicated – TB , CA
OCCUPATION Mining or tunneling Quarrying[6]
Drilling Crushing stone Chipping Grinding Sandblasting Grinding or polishing in pottery or stone work [7]
Foundry work Cement manufacturing Glass manufacturing Masonry Blast furnaces Coal mining Construction[8]
Cutting or manufacturing heat-resistant bricks Dental laboratory technician
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