cxr: silico-tuberculosis

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

THANK YOU