A 52-year-old female patient presented with complaints of breathlessness and dry cough for the past 6 months. She has a history of treated pulmonary tuberculosis 3 years ago and treated Pott's spine 2 years ago. Examination revealed wheezing and generalized pigmentation. Chest X-ray showed bilateral lung parenchymal lesions and hilar lymph node calcifications. The final diagnosis was occupational lung disease of silicosis complicated by silicotuberculosis due to exposure to silica particles in her work in sand filtration for brick production.

1. IMAGE OF THE WEEK

2. CASE A 52 yr old female patient came with COMPLAINTS: Breathlessness Dry cough on & off for past 6 months HISTORY: Had similar episode before 3 years, treated in stanley – lost records H/O sputum positive PTB treated with ATT 3 years back H/O pott’s spine treated 2 years back

3. Occuptional history: Working in sand filtration segment in brick production unit. On examination: GC good poorly built & nourished generalised pigmentation all over body more significant in face CVS- s1,s2 + RS – blt wheeze +

4. PLAIN X RAY

5. 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

6. UPPER / MIDDLE LOBE SECTIONS

7. LOWER LOBE SECTIONS

9. IMPRESSION

10. DIGITAL X RAY

11. DD FOR BILATERAL HILAR CALCIFICATIONS Sarcoidosis Silicosis Post irradiation of hodgkins lymphoma Blastomycosis Sleroderma Histoplasmosis Amyloidosis

12. EGG SHELL CALCIFICATION RADIOLOGICAL 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

13. SLATE GREY PIGMENTATION

14. FINAL DIAGNOSIS OCCUPATIONAL LUNG DISEASE SILICOSIS Chronic complicated type- silicotuberculosis EXPOSURE TO SILVER COMPOUNDS

15. SILICOSIS Inhalation of crystalline silica TYPES: Chronic – >10 yrs , eggshell calc. Accelerated – 5-10 yrs , PMF Acute – silicoproteinosis - hypersensitivity Complicated – TB , CA

16. 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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