Silicosis differential diagnosis
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Overview
- Silicosis must be differentiated from other diseases with similar presenting complaints such as asbestosis, coal workers pneumoconiosis and infections such as mycobacterial, fungal and parasitic infections and pulmonary malignancy.
Other pneumoconiosis
- Silicosis is differentiated from other occupational disease like asbestosis from the history of exposure and occupational history. Both coal workers pneumoconiosis and silicosis may yield multiple pulmonary nodules that range in size from 1 to 10 cm and are usually located in the upper lobes .In 5 percent of cases, accompanying lymph node enlargement with eggshell calcification is present. Superimposed tuberculosis has to be suspected when calcification and cavitation of these nodules are noted. Beryllium-associated lung disease can present with multiple pulmonary nodules and mimic the radiologic appearance of sarcoidosis. Caplan’s disease is a combination of rheumatoid arthritis and coal-worker’s pneumoconiosis that manifests with multiple pulmonary nodules[1]
Malignant diseases
- Multiple pulmonary nodules that are ≥1 cm in diameter or detected by conventional chest radiography are most likely due to metastatic disease from a malignant solid organ primary tumor [2].[3]
- Multiple pulmonary nodules that are <5 mm in diameter, juxtaposed to either the visceral pleura or an interlobar fissure, and detected incidentally, are more likely to be benign lesions, such as granulomata, scars, or intraparenchymal lymph nodes [4]
Mycobacterial infections
- Both Tuberculosis and atypical mycobacterial infections can yield multiple nodules, which exceed 5 mm in diameter and may be the result of endobronchial spread of disease. Overall, multiple nodules caused by mycobacterial infections are relatively rare in comparison to the other characteristic imaging manifestations of tuberculosis and atypical mycobacterial infections.[5]
Fungi
- Multiple pulmonary nodules may be due to a fungal infection such as histoplasmosis, coccidioidomycosis, blastomycosis, or cryptococcosis. Invasive aspergillosis is likely in immunocompromised hosts. Nodules due to fungal infection tend to be 0.5 to 3 cm in diameter and do not have a predilection for a specific region of the lungs. Nodules usually show cavitation or calcification[6][7]
Parasites
- Humans acquire the Paragonimus westermani infection by ingesting uncooked fresh water crabs or crayfish that harbor the metacercarial stage of the parasite. Paragonimus westermani is a fluke that is endemic in parts of China, Korea, Japan, the Philippines, and Taiwan. The typical radiographic appearance of Paragonimus consists of multiple cavities with surrounding foci of consolidation, which may represent hemorrhage, most commonly located in the lower and middle lung zones. CT may also reveal linear shadows adjacent to nodules or consolidations; these shadows represent burrowing tracts [8]
References
- ↑ Stark P, Jacobson F, Shaffer K (1992). "Standard imaging in silicosis and coal worker's pneumoconiosis". Radiol Clin North Am. 30 (6): 1147–54. PMID 1410305.
- ↑ Ginsberg MS, Griff SK, Go BD, Yoo HH, Schwartz LH, Panicek DM (1999). "Pulmonary nodules resected at video-assisted thoracoscopic surgery: etiology in 426 patients". Radiology. 213 (1): 277–82. doi:10.1148/radiology.213.1.r99oc08277. PMID 10540672.
- ↑ Gross BH, Glazer GM, Bookstein FL (1985). "Multiple pulmonary nodules detected by computed tomography: diagnostic implications". J Comput Assist Tomogr. 9 (5): 880–5. PMID 3861629.
- ↑ Ahn MI, Gleeson TG, Chan IH, McWilliams AM, Macdonald SL, Lam S; et al. (2010). "Perifissural nodules seen at CT screening for lung cancer". Radiology. 254 (3): 949–56. doi:10.1148/radiol.09090031. PMID 20177105.
- ↑ Fabreguet I, Francis F, Lemery M, Choudat L, Papo T, Sacre K (2009). "A 76-year-old man with multiple pulmonary nodules". Chest. 135 (4): 1094–7. doi:10.1378/chest.08-2049. PMID 19349406.
- ↑ Gaeta M, Blandino A, Scribano E, Minutoli F, Volta S, Pandolfo I (1999). "Computed tomography halo sign in pulmonary nodules: frequency and diagnostic value". J Thorac Imaging. 14 (2): 109–13. PMID 10210483.
- ↑ Gurney JW, Conces DJ (1996). "Pulmonary histoplasmosis". Radiology. 199 (2): 297–306. doi:10.1148/radiology.199.2.8668768. PMID 8668768.
- ↑ BREM TH, COHN HA (1946). "Paragonimus westermanii". Radiology. 46: 511–3. doi:10.1148/46.5.511. PMID 20983083.