An Unusual Case of Large Opacity in Pneumoconiosis

Abstract

Coal dust inhalation can result in industrial bronchitis and coal workers’ pneumoconiosis (CWP) presenting as either simple pneumoconiosis or complicated CWP. With prolonged excessive exposure, small opacities in simple pneumoconiosis may coalesce and form larger opacities, recognized as progressive massive fibrosis (PMF) greater than 1 cm in diameter on a chest X-ray. Even though the degree of respiratory impairment or the presence of symptoms does not always correlate well with the extent of PMF, most workers frequently describe dyspnea, a cough and sputum production. It may be caused by deviation of the prominent area of coalescence, loss of upper zone lung volume, elevation of the hila, and basilar emphysema. We present a case of large opacity in pneumoconiosis which included a finding of ischemic necrosis. Rapid change in the solitary mass caused a diagnostic dilemma in attempting to distinguish a primary or metastatic neoplasm from an unusual presentation of PMF.