Presentation
Hospitalized for intermittent fever. History of advanced silicosis. Lung transplant candidate.
Patient Data
Severe apical fibrosis and diffuse reticulonodular pattern in both lungs.
mild supraclavicular lymphadenopathy (upper edge of scan).
non-enlarged elliptical axillary lymph nodes with no fatty hila
mediastinal lymphadenopathy in many stations, with subcarinal nodes reaching 17 mm (short axis)
bilateral hilar lymphadenopathy with delicate peripheral nodules of calcification
severe bilateral pulmonary fibrosis, particularly in the upper lobes. Innumerable perilymphatic nodules diffusely dispersed throughout the lungs
bilateral posteromedial pleural thickening
supradiaphragmatic lymphadenopathy, with nodes measuring up to 17 mm (short axis).
gastrohepatic ligament lymphadenopathy, with the largest mass/conglomerate measuring 39 mm across.
hypodense lesion in posteromedial aspect of the spleen measuring 30 x 23 x 30 mm, unchanged compared to previous scan (not shown) - probably a hemangioma.
the celiac trunk is severely stenotic at its origin.
Case Discussion
Typical features of progressive massive fibrosis on a background of pulmonary nodules and lymphadenopathy.
Occupational history is essential to the diagnosis.
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