Silikose

Silicosis
simple
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Röntgenbild
einer Silikose mit multiplen kleinnodulären Verdichtungen. Zusätzlich alte Rippenfrakturen links.
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Classic
simple silicosis with bacterial bronchopneumonia. Coronal MIP image shows a significant reduction of parenchymal consolidations and confirms the multiple bilateral small nodules.
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Classic
simple silicosis with bacterial bronchopneumonia. Coronal MIP image confirms the enlarged mediastinal and hilar lymph nodes.
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An industrial
worker with shortness of breath. Large bilateral opacities with irregular margins in bilateral upper and mid lobes. Mediastinum - Multiple enlarged lymph nodes with egg shell calcification in the pre and paratracheal, prevascular, subcarinal regions and bilateral hila.
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An industrial
worker with shortness of breath. Multiple calcified lymph nodes noted in right paratracheal and bilateral hilar region. Homogeneous opacities noted in bilateral mid and lower zones due to pneumoconiosis (silicosis).
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The
anatomical compartments and their connections as demonstrated by ectopic air. The same patient as in Fig. 2. Axial CT in the “lung window” depicts the thoracoabdominal continuum. a The anterior blending of the endothoracic and endoabdominal fascias outlined by air: one in the midline, between the two slips of sternal origin of the diaphragm on the back of xiphoid process, and two parasagittal between the sternal and costal origins of the diaphragm—the sternocostal triangles or foramen of Morgagni. b The crura have separated, forming the oesophageal hiatus. The subpleural space of the thorax and subperitoneal space of the abdomen are in continuity through the subserous space within the oesophageal and aortic hiatus
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The
anatomical compartments and their connections as demonstrated by ectopic air. Unilateral secondary spontaneous pneumothorax in a 69-year-old man with silicosis, and extensive emphysematous changes in lungs, with bullae. Axial CT scan depicts air spread in the mediastinum as a continuum space, and subcutaneous planes after percutaneous drainage of pneumothorax (chest tube not shown)
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CT findings
of high-attenuation pulmonary abnormalities. Silicosis. Axial CT at the mediastinal window shows multiple calcified nodules with a conglomerate mass of fibrosis in the upper lobes (arrows)
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Classic
simple silicosis with bacterial bronchopneumonia. Coronal MIP image shows a significant reduction of parenchymal consolidations and confirms the multiple bilateral small nodules.
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An industrial
worker with shortness of breath. Remaining lung shows groung glass opacities, interstitial thickening and cystic areas. There is volume loss in bilateral lungs.
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Chest
X-ray/Silicosis/ILO Classification/2-2 R-R
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Classic
simple silicosis with bacterial bronchopneumonia. Coronal MIP image shows the enlarged mediastinal and hilar lymph nodes with peripheral calcifications.
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Classic
simple silicosis with bacterial bronchopneumonia. Coronal MIP image shows the bilateral multiple perilymphatic nodules and the consolidation of the right lower lobe.
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Classic
simple silicosis with bacterial bronchopneumonia. Chest CT axial image shows multiple patchy confluent areas of ground glass and airspace consolidation of the right lower lobe, with associated thickening of the interlobular septa.
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Classic
simple silicosis with bacterial bronchopneumonia. Chest CT axial image shows diffuse multiple small perilymphatic lung nodules, predominantly located in the upper lobes.
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Komplizierte
Silikose
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Silicosis (plural: silicoses) is a fibrotic pneumoconiosis caused by the inhalation of fine particles of crystalline silicon dioxide (silica). Occupations such as mining, quarrying, and tunnelling are associated with silicosis.

The disease occurs in two clinical forms that are subdivided by their temporal relationship to the exposure to silica:

  • acute silicosis: manifests as alveolar silicoproteinosis
  • classic silicosis: manifests as a chronic interstitial reticulonodular disease

The classic form is much more common than the acute form and can be classified as simple or complicated, according to the radiographic findings:

  • simple silicosis: pattern of small and round or irregular opacities
  • complicated silicosis: large conglomerate opacities that equate to progressive massive fibrosis

In some situations, there is a rapid progression of the disease which is sometimes termed accelerated silicosis.

Radiographic features

Acute silicosis
Plain radiograph

Radiographic findings on chest x-ray can consist of bilateral consolidation and/or ground-glass opacities, which tend to appear in perihilar regions.

CT

CT findings include:

  • numerous bilateral centrilobular nodular ground-glass opacities
  • multifocal patchy ground-glass opacities
  • consolidation
Classic/simple silicosis
Plain radiograph

Chest radiograph shows multiple nodular opacities:

  • well-defined and uniform in shape and attenuation
  • ranging from 1 to 10 mm in diameter
  • predominantly located in the upper lobe and posterior portion of the lung
  • calcification of nodules is seen on chest radiographs in 10-20% of patients
CT

At CT, features of simple silicosis include:

  • multiple small pulmonary nodules
  • hilar and mediastinal lymphadenopathy, which may precede the appearance of parenchymal nodular lesions
  • calcification of lymph nodes
    • common and typically occurs at the periphery of the node
    • this eggshell calcification pattern is highly suggestive of silicosis
Classic complicated silicosis
Plain radiograph

On a chest radiograph, complicated silicosis is usually indicated by large symmetric bilateral opacities that are:

  • 1 cm or more in diameter and with an irregular margin
  • commonly in the middle lung zone or peripheral one-third of the lung
  • gradually migrating toward the hilum, leaving emphysematous lung tissue between the fibrotic tissue and the pleural surface.
CT

CT features are focal soft-tissue masses, often with irregular or ill-defined margins and calcifications, surrounded by areas of emphysematous change.

Treatment and prognosis

Treatment is to remove the exposure, although silicosis may progress despite removal from the dust environment.

In acute silicosis particularly, the clinical course is usually progressive and ends in death due to cor pulmonale and respiratory failure therapy with corticosteroids

Carcinoma and tuberculosis are potentially serious complications of silicosis.

Differential diagnosis

Possible imaging differential considerations include:

See also

Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu Silikose:
verkalkte
mediastinale Lymphknoten
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Sarkoidose
 
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verkalkte
Lymphknoten
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Lungenfibrose
 
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Asbestose
 
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Pneumonokoniose
 
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hyperdenser
Lymphknoten
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alveoläre
Mikrolithiasis
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