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Pleural Disease in Silicosis: Pleural Thickening, Effusion, and Invagination¹

¹ From the Departments of Radiology (H.A., M.F.) and Pathology (K.H.), Dokkyo University School of Medicine, Mibu, Tochigi 321-0293, Japan; Departments of Respiratory Medicine (Y.S.) and Radiology (H.S., H.M.), Keihai Rosai Hospital for Silicosis, Nikko, Japan; and Department of Environmental Health, Fukui Medical School, Fukui, Japan (N.S.). Received August 4, 2004; revision requested October 8; revision received November 2; accepted November 12. Address correspondence to H.A. (e-mail: arakawa{at}dokkyomed.ac.jp).

View larger version (16K): [in a new window]   Figure 1. Bland-Altman plot for radiographic profusion of small opacities rated by two radiologists. Mean difference was –0.05, and the limits of agreement between two observers in each patient were small (range, –2 to 2). SD = standard deviation.

View larger version (116K): [in a new window]   Figure 2a. CT scans and autopsy findings in a 74-year-old man with silicosis (former tunnel worker). (a, b) Transverse spiral CT scans obtained with 10-mm section thickness. (a) Lung window scan shows PMF (arrows) and pleural effusion in both lower lobes, surrounded by multiple small pneumoconiotic nodules. (b) Mediastinal window scan shows a thickened band (large arrow) between PMF and the thickened pleura on the left side. The PMF on the right side is adherent to the pleura, which shows smooth thickening at the site of attachment (small arrows). (c) Gross lung specimen from a coronal section confirms invagination of diffuse thick pleura into the black PMF on the left side (arrow, right side of image). The thickened band in b proved the continuation of thickened pleura. The right pleura also shows diffuse thickening and invagination (arrows, left side of image) into the PMF.

View larger version (96K): [in a new window]   Figure 2b. CT scans and autopsy findings in a 74-year-old man with silicosis (former tunnel worker). (a, b) Transverse spiral CT scans obtained with 10-mm section thickness. (a) Lung window scan shows PMF (arrows) and pleural effusion in both lower lobes, surrounded by multiple small pneumoconiotic nodules. (b) Mediastinal window scan shows a thickened band (large arrow) between PMF and the thickened pleura on the left side. The PMF on the right side is adherent to the pleura, which shows smooth thickening at the site of attachment (small arrows). (c) Gross lung specimen from a coronal section confirms invagination of diffuse thick pleura into the black PMF on the left side (arrow, right side of image). The thickened band in b proved the continuation of thickened pleura. The right pleura also shows diffuse thickening and invagination (arrows, left side of image) into the PMF.

View larger version (144K): [in a new window]   Figure 2c. CT scans and autopsy findings in a 74-year-old man with silicosis (former tunnel worker). (a, b) Transverse spiral CT scans obtained with 10-mm section thickness. (a) Lung window scan shows PMF (arrows) and pleural effusion in both lower lobes, surrounded by multiple small pneumoconiotic nodules. (b) Mediastinal window scan shows a thickened band (large arrow) between PMF and the thickened pleura on the left side. The PMF on the right side is adherent to the pleura, which shows smooth thickening at the site of attachment (small arrows). (c) Gross lung specimen from a coronal section confirms invagination of diffuse thick pleura into the black PMF on the left side (arrow, right side of image). The thickened band in b proved the continuation of thickened pleura. The right pleura also shows diffuse thickening and invagination (arrows, left side of image) into the PMF.

View larger version (99K): [in a new window]   Figure 3a. CT scans and autopsy findings in a 61-year-old man with silicosis (former tunnel worker). (a, b) Transverse CT scans obtained with 10-mm collimation. (a) Lung window scan shows rounded masses in both upper lobes (). The mass in the left lobe is attached to the pleura, and the mass in the right lobe is not. There are multiple silicotic nodules around the masses. (b) Mediastinal window scan shows thickened pleura (arrows) between the left mass and chest wall, as well as proliferation of the subpleural fat. Note the many eggshell calcifications in the mediastinal lymphadenopathy. (c) Gross lung specimen from a coronal section shows diffuse pleural thickening and invagination (arrow) into PMF on the left side. Because the PMF is attached to the pleura, invagination was not identified as a thick band on the CT scans.

View larger version (92K): [in a new window]   Figure 3b. CT scans and autopsy findings in a 61-year-old man with silicosis (former tunnel worker). (a, b) Transverse CT scans obtained with 10-mm collimation. (a) Lung window scan shows rounded masses in both upper lobes (). The mass in the left lobe is attached to the pleura, and the mass in the right lobe is not. There are multiple silicotic nodules around the masses. (b) Mediastinal window scan shows thickened pleura (arrows) between the left mass and chest wall, as well as proliferation of the subpleural fat. Note the many eggshell calcifications in the mediastinal lymphadenopathy. (c) Gross lung specimen from a coronal section shows diffuse pleural thickening and invagination (arrow) into PMF on the left side. Because the PMF is attached to the pleura, invagination was not identified as a thick band on the CT scans.

View larger version (164K): [in a new window]   Figure 3c. CT scans and autopsy findings in a 61-year-old man with silicosis (former tunnel worker). (a, b) Transverse CT scans obtained with 10-mm collimation. (a) Lung window scan shows rounded masses in both upper lobes (). The mass in the left lobe is attached to the pleura, and the mass in the right lobe is not. There are multiple silicotic nodules around the masses. (b) Mediastinal window scan shows thickened pleura (arrows) between the left mass and chest wall, as well as proliferation of the subpleural fat. Note the many eggshell calcifications in the mediastinal lymphadenopathy. (c) Gross lung specimen from a coronal section shows diffuse pleural thickening and invagination (arrow) into PMF on the left side. Because the PMF is attached to the pleura, invagination was not identified as a thick band on the CT scans.

View larger version (76K): [in a new window]   Figure 4a. CT scans and autopsy findings in an 86-year-old man with silicosis (former metal ore miner). (a, b) Transverse CT scans obtained with 10-mm collimation. (a) Lung window scan shows a rounded opacity (PMF) in the right lower lobe. Lung volume is reduced, and the major fissure is displaced (arrows). CT features were those of rounded atelectasis. Note multiple small nodules of silicosis in both lower lobes. (b) Mediastinal window scan at the same level as in a shows a thickened band (arrow) that connects PMF with the thickened pleura. There is a small amount of ipsilateral pleural effusion and multiple calcifications in the PMF. (c) Gross lung specimen from a coronal section shows diffuse pleural thickening in the right lung base and invagination (arrow) into the mass. (d) Photomicrograph shows coalescence of calcified silicotic nodules forming the mass. Intervening lung tissue is black pigmented and shows various degrees of interstitial fibrosis and atelectasis. The pathologic features were compatible with PMF. Invagination of thickened pleura (arrows) into the mass is apparent. (Elastic-Goldner stain, original size.)

View larger version (110K): [in a new window]   Figure 4b. CT scans and autopsy findings in an 86-year-old man with silicosis (former metal ore miner). (a, b) Transverse CT scans obtained with 10-mm collimation. (a) Lung window scan shows a rounded opacity (PMF) in the right lower lobe. Lung volume is reduced, and the major fissure is displaced (arrows). CT features were those of rounded atelectasis. Note multiple small nodules of silicosis in both lower lobes. (b) Mediastinal window scan at the same level as in a shows a thickened band (arrow) that connects PMF with the thickened pleura. There is a small amount of ipsilateral pleural effusion and multiple calcifications in the PMF. (c) Gross lung specimen from a coronal section shows diffuse pleural thickening in the right lung base and invagination (arrow) into the mass. (d) Photomicrograph shows coalescence of calcified silicotic nodules forming the mass. Intervening lung tissue is black pigmented and shows various degrees of interstitial fibrosis and atelectasis. The pathologic features were compatible with PMF. Invagination of thickened pleura (arrows) into the mass is apparent. (Elastic-Goldner stain, original size.)

View larger version (137K): [in a new window]   Figure 4c. CT scans and autopsy findings in an 86-year-old man with silicosis (former metal ore miner). (a, b) Transverse CT scans obtained with 10-mm collimation. (a) Lung window scan shows a rounded opacity (PMF) in the right lower lobe. Lung volume is reduced, and the major fissure is displaced (arrows). CT features were those of rounded atelectasis. Note multiple small nodules of silicosis in both lower lobes. (b) Mediastinal window scan at the same level as in a shows a thickened band (arrow) that connects PMF with the thickened pleura. There is a small amount of ipsilateral pleural effusion and multiple calcifications in the PMF. (c) Gross lung specimen from a coronal section shows diffuse pleural thickening in the right lung base and invagination (arrow) into the mass. (d) Photomicrograph shows coalescence of calcified silicotic nodules forming the mass. Intervening lung tissue is black pigmented and shows various degrees of interstitial fibrosis and atelectasis. The pathologic features were compatible with PMF. Invagination of thickened pleura (arrows) into the mass is apparent. (Elastic-Goldner stain, original size.)

View larger version (158K): [in a new window]   Figure 4d. CT scans and autopsy findings in an 86-year-old man with silicosis (former metal ore miner). (a, b) Transverse CT scans obtained with 10-mm collimation. (a) Lung window scan shows a rounded opacity (PMF) in the right lower lobe. Lung volume is reduced, and the major fissure is displaced (arrows). CT features were those of rounded atelectasis. Note multiple small nodules of silicosis in both lower lobes. (b) Mediastinal window scan at the same level as in a shows a thickened band (arrow) that connects PMF with the thickened pleura. There is a small amount of ipsilateral pleural effusion and multiple calcifications in the PMF. (c) Gross lung specimen from a coronal section shows diffuse pleural thickening in the right lung base and invagination (arrow) into the mass. (d) Photomicrograph shows coalescence of calcified silicotic nodules forming the mass. Intervening lung tissue is black pigmented and shows various degrees of interstitial fibrosis and atelectasis. The pathologic features were compatible with PMF. Invagination of thickened pleura (arrows) into the mass is apparent. (Elastic-Goldner stain, original size.)