Silicosis: The Daily PANCE Blueprint
A 61-year-old man presents with 2 years of slowly progressive exertional dyspnea and a dry cough. He worked for 25 years as a sandblaster and later cutting stone countertops. He has never smoked. Lung examination shows scattered fine crackles. A chest radiograph shows multiple small nodules in the upper lobes and enlarged hilar lymph nodes with "eggshell" calcification. Pulmonary function testing shows a restrictive pattern. Which of the following is the most likely diagnosis?
A. Asbestosis
B. Silicosis
C. Coal workers' pneumoconiosis
D. Berylliosis
E. Sarcoidosis
Answer and topic summary
The answer is B. Silicosis
Silicosis is a fibrotic lung disease from inhaled crystalline silica, seen in sandblasting, quarrying, mining, foundry work, and cutting engineered-stone countertops. It favors the upper lobes, and “eggshell” calcification of the hilar nodes is its classic radiographic sign. Silica damages macrophages, so patients have a much higher risk of tuberculosis; screen for latent TB. It also raises the risk of lung cancer. There is no drug that reverses it: remove the exposure, stop smoking, vaccinate, and refer for transplant in end-stage disease. Asbestosis favors the lower lobes with pleural plaques after shipbuilding or insulation work. Coal workers’ pneumoconiosis also affects the upper lobes but follows coal mining. Berylliosis (aerospace and electronics) causes granulomas that mimic sarcoidosis, and sarcoidosis needs no exposure history and classically shows symmetric bilateral hilar adenopathy.
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