Progressive massive fibrosis

Progressive massive fibrosis (PMF) refers to the formation of large mass-like conglomerates, predominantly in the upper pulmonary lobes, associated with radiating strands. These classically develop in the context of certain pneumoconioses (especially coal worker's pneumoconiosis and silicosis) although similar mass-like densities have occasionally been described with talcosis.

Radiographic features

Plain radiograph

May be seen as large symmetric bilateral opacities with irregular margins in the upper lobes 3.


Mass-like areas of lung opacification associated with radiating strands are seen; the "sausage-shaped" mass is characteristic. These regions commonly contain air bronchograms and calcifications 4. These areas can shrink over time and migrate towards the hilar regions 5.


Magnetic resonance imaging can be helpful for distinguishing between progressive massive fibrosis and lung cancer 3. The latter typically appears as T2-bright, whereas progressive massive fibrosis appears as T2-dark (compared to skeletal muscle) 3.

The most frequent MRI appearance are regions which have following signal characteristics 1,2:

  • T1: iso- to hyperintense
  • T2:
    • hypointense (compared with skeletal muscle)
    • areas of internal high T2 signal
    • there may be rim enhancement
Nuclear medicine

On PET-CT, progressive massive fibrosis can be FDG-avid 3.

Differential diagnosis

Possible differential considerations include:

In some situations consider pulmonary manifestations of sarcoidosis

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Article information

rID: 20929
System: Chest
Synonyms or Alternate Spellings:
  • PMF
  • Progressive massive fibrosis (PMF)

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Cases and figures

  • Case 1: with silicosis
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  • Case 2: with silicosis
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  • Case 3
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  • Case 4
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  • Case 5: with silicosis
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  • Case 6
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  • Case 7
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  • Case 8
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  • Case 9
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  • Case 10: due to silicosis
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  • Case 11: from prostate carcinoma
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