10th May 2021

ICRI Case of the Week

Contributed by : Dr Taruna Yadav, Dr Siddhi Chawla,
Dr Pushpinder Khera
AIIMS, Jodhpur

Copyright of the Case belongs to : Dr Taruna Yadav
[email protected]

Clinical Details

• 75-year-old male, chronic smoker, presented with
complaints of right posterior chest swelling since 1
month, progressively increasing in size.

• No history of fever, pain or other systemic symptoms.
• Stoneworker by occupation.
• O/E – Hard diffuse swelling felt in right paraspinal

region.
• Laboratory parameters were within normal limits.
• Chest X-ray followed by Contrast enhanced CT scan

were done.



Axial

Axial
Bone window axial

Sagittal
Coronal

Lung window axial and coronal

WHAT IS YOUR DIAGNOSIS ?

Imaging Findings

• Chest radiograph:

– Multifocal fibro-nodular
opacities with areas of reticular
thickening in bilateral lung fields
predominantly in bilateral
upper lobes.

– A well defined right
paravertebral opacity (arrow)
with demarcated right lateral
margin.

Imaging Findings

• CECT images:

– Bullous emphysematous changes in
apices of bilateral upper lobes (Red
arrow) along with diffuse paraseptal
and centrilobular emphysematous
changes in bilateral lung fields.

– Multiple fibroatelectatic bands with
conglomerated fibrocalcific and
discrete noncalcified centrilobular
nodules (green arrow) predominantly in
bilateral upper lobes

– Multiple calcified lymph nodes in
paratracheal, subcarinal, AP window
and bilateral hilar region (yellow
arrow).

Imaging Findings

• A large irregular heterogeneously
enhancing soft tissue mass lesion with
areas of central necrosis in right para-
vertebral compartment at level of D10-
12 vertebra (green arrow).

• The lesion is also infiltrating right
diaphragmatic crura, right pleural
space, posterobasal segment of right
lower lobe and right perinephric region
(retroperitoneum)

• The lesion is predominantly involving
right paraspinal muscles with
destruction of adjacent ribs (Right 10-
12th ribs posteriorly) and right
transverse process and part of body of
D10-12 vertebrae.

Differential Diagnoses

• Primary lung carcinoma
• Chest wall sarcoma
• Plasmacytoma

In a background of Complicated Silicosis

Final Diagnosis

Complicated Silicosis with
Squamous Cell Carcinoma of Lung
with Chest Wall Invasion

Discussion

• Classic occupational settings for silicosis: Miners,
foundry workers, sandblasters, ceramic,
construction workers.

• Two clinical forms:

– Acute silicosis: Alveolar silicoproteinosis
– Classic silicosis: Chronic interstitial reticulonodular

disease. Types:

• Simple silicosis : small and round or irregular opacities,
• Complicated silicosis or progressive massive fibrosis: large

conglomerate opacities.

• Lung, renal carcinoma and tuberculosis are
potential serious complications of silicosis.

Discussion

Lung cancer with Silicosis :

• Silica, or silicon dioxide (SiO2) naturally occurs in both
crystalline and amorphous forms. Crystalline silica in the
form of quartz or cristobalite dust causes the lung cancer.

• Smoking is the single most important risk factor
contributing to the development of lung cancer. The joint
effect of silica and smoking on lung cancer is more than
additive.

• Malignancies with Silicosis: Squamous cell > Small cell
carcinoma > Adenocarcinoma > Large cell carcinoma.

• Workers with a cumulative silica exposure of >30 years
should be assessed by chest CT to enhance the likelihood
of detecting lung cancer as early as possible.

References

1. Chong S, Lee KS, Chung MJ, Han J, Kwon OJ, Kim TS.
Pneumoconiosis: comparison of imaging and pathologic
findings. Radiographics. 2006 Jan-Feb;26(1):59-77.

2. Kim KI, Kim CW, Lee MK, Lee KS, Park CK, Choi SJ, Kim
JG. Imaging of occupational lung disease. Radiographics.
2001 Nov-Dec;21(6):1371-91.

3. Cox CW, Rose CS, Lynch DA. State of the art: Imaging of
occupational lung disease. Radiology. 2014
Mar;270(3):681-96.

4. Tashiro T, Yamasaki T, Nagai H, Yamasaki H, Kuroda Y,
Shigeno H, Goto J, Nasu M, Nagato H. [Silicosis and lung
cancer]. Nihon Kyobu Shikkan Gakkai Zasshi. 1989
Jul;27(7):784-8.