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Progressive massive fibrosis

Case contributed by Ian Bickle
Diagnosis certain

Presentation

Shortness of breath. Retired coal miner.

Patient Data

Age: 80 years
Gender: Male
x-ray

Bilateral reticulonodular change at both apices.   

6.9 cm mass in the right upper lobe.  No cavitation or calcification.

No mediastinal lymphadenopathy.

Heart size normal.

6.9 cm mass with internal calcification in the right upper lobe with tethering to the pleural surface.Traction bronchiectasis in the right upper lobe.

Multiple nodules in both lungs, some of which are calcified.

Multiple calcified mediastinal and retrocrural lymph nodes.

3 years later

x-ray

No change in appearances from the radiograph of 4 years prior.

Case Discussion

The radiographic appearances, occupational history and static interval changes over several years are consistent with progressive massive fibrosis.  

The patient was a former coal miner in a region of the UK which until 30 years ago was renown for its plethora of collieries which employed a large proportion of the community.

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