CXR: Silico-Tuberculosis

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CXR: Silico-Tuberculosis

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

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