Notable features

Notable features of the 10 radiographs can be found in of the Repository

Radiograph 1¹.  Arrangement along broncho-vascular bundles.

Arrangement along the bronchi-vascular bundles and variability in size of nodules in silicosis and tuberculosis.

Radiograph 2¹.   Florid example of arrangement along broncho-vascular bundles.

Florid example of the arrangement of nodules along the bronchi-vascular bundles of silicosis and tuberculosis.

Radiograph 3. Previous tuberculosis with silicosis.

Previous tuberculosis with destruction and fibrosis of the left lung and fibrosis right lung. 1/1 q/q (also read as q/p) opacities in upper part of right middle zone. Silicotuberculosis. This is Case 1 in Maboso et al. 2022.

Radiograph 4.  Previous tuberculosis doubtful silicosis.

Previous tuberculosis with destruction and fibrosis right lung and fibrosis left lung. Opacities visible in left mid-lower zone. Silicosis doubtful. The individual had, however,  had 27 years of silica exposure. The benefit of the doubt may favour silicosis for workers’ compensation assessment. Chest CT may be helpful

Radiograph 5. Silicotuberculosis.

This is Case 2 in Maboso et al. 2022. The article reads “..bilateral, multiple nodules of q size, mostly in the upper and middle zones, with extensive fibrotic changes bilaterally. Cystic and peribronchiolar changes, pleural thickening and diffuse loss of bronchovascular markings are also identifiable. Cavities are noted in the upper zones bilaterally.” Assessment was silicotuberculosis with features of both inactive and active tuberculosis.

Radiograph 6. Tuberculosis in silica exposed individual.

Fibrocystic changes. Occasional nodules probably not silicosis as non-uniform in size and distribution. Also, occur predominantly in the area with fibrosis. Unexplained large opacities in lower zones. Previous and possible active tuberculosis. Silicosis doubtful.

Radiograph 7. Tuberculosis with doubtful silicosis.

Bilateral fibrocystic changes and features of bronchiectasis. Bilateral small middle zone opacities. Distribution, asymmetry and clustering atypical of silicosis. Unexplained opacities left middle zone and right lower zone.

Radiograph 8. Tuberculosis and doubtful silicosis.

Bilateral fibrocystic changes. Poorly defined nodules 3-6 mm (q/r) bilaterally with clustering. Non-uniform size and distribution atypical of silicosis. Air-fluid level right upper zone. Features of active disease process right lower zone. Tuberculosis probable.  Silicosis doubtful. Repeat radiograph post appropriate treatment may be helpful.

Radiograph 9. Silicotuberculosis.

The radiograph shows marked volume loss of the left lung with extensive pleural thickening with calcification. The Maboso et al. 2022 authors concluded that the changes were consistent with old, healed tuberculosis but other causes were not excluded. There were uniformly sized rounded opacities read as 2/2 q/r in the right upper and mid zone. The assessment was silicotuberculosis.

Radiograph 10. Tuberculosis in silica exposed individual.

This is Case 4 in Maboso et al. 2022. There is sparse nodulation varying in size and shape and cystic change, tracheal deviation to the right and volume loss.   The Maboso et al. 2022 authors concluded that the changes “….were not consistent with silicosis, neither in respect of nodular profusion (read as ILO 0/0) nor of progressive massive fibrosis (PMF).” A radiological assessment of tuberculosis was made.

Reference

Maboso B, Rees D, teWater Naude J, Goodman H. Ehrlich R.  Difficulties in distinguishing silicosis and pulmonary tuberculosis in silica exposed gold miners – a report of four cases. Am J Ind Med 2023;1–10.

Footnote 1: Images 1 and 2 were first published in Solomon A and Rees D. Back to Basics – the chest radiograph in silica associated tuberculosis. Occup Health Southern Afr 2010;16:25-27.