Silicosis differential diagnosis
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Overview
- Silicosis must be differentiated from other diseases that cause pulmonary fibrosis and pulmonary nodules on imaging, such asasbestosis,coal workers pneumoconiosis, mycobacterial, fungal, and parasitic infectionsinfections, and pulmonary malignancy.
Differential Diagnosis
Other pneumoconiosis
- The distinction between silicosis and other occupational disease (such as asbestosis or berylliosis) is made based on history of occupational exposure.
- Both coal workers pneumoconiosis and silicosis may result in the development of pulmonary nodules (diameter range from 1 to 10 cm) that are typically located in the upper pulmonary lobes .
- Beryllium-associated lung disease may 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 are likely to be 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 asgranulomata, scars, or intraparenchymal lymph nodes.[4]
Mycobacterial infections
- Both tuberculosis and atypical mycobacterial infections can result in the development of multiple nodules, which exceed 5 mm in diameter. 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, namely histoplasmosis, coccidioidomycosis, blastomycosis, or cryptococcosis.
- Invasive aspergillosis is more common among 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. Fungal nodules usually demonstrate eithercavitationorcalcification.[6][7]
Parasites
- Humans acquire the paragonimus westermani infection by ingesting either 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 is the development of multiple cavities with surrounding foci of hemorrhagic consolidation most commonly located in the lower and middle lung zones. CT may also demonstrate either linear adjacent to the nodules, suggestive of parasitic burrowing tracts.[8]