Silicotuberculosis with oesophagobronchial fistulas and broncholithiasis: a case report.

A 76-year-old woman was admitted to the hospital four times from November 2007 to June 2009. In this complex case, the patient had silicosis complicated by broncholithiasis, oesophagobronchial fistulas, and relapsed tuberculosis. She had worked as a stone crusher for 3 years and was exposed to a large amount of quartz dust. Barium oesophagography, gastroesophageal endoscopy, and biopsy suggested oesophageal-related chronic inflammation and ulceration, which may have caused the repeated oesophagobronchial fistulas. Bronchoscopy revealed a free broncholithiasis in the left mainstem bronchus. The patient was admitted a fourth time because of silicotuberculosis relapse. After 9 months of antituberculosis treatment, the patient recovered and was still clinically well at the time of this writing.

Silicotuberculosis with Esophagobronchial Fistula and Broncholithiasis.

A 69-year-old woman was admitted to hospital 4 times from November 2007 to June 2009. The patient had silicosis complicated by broncholithiasis, esophagobronchial fistula, and relapsed tuberculosis. She had worked as a stone crusher for 3 years and was exposed to a large amount of quartz dust. Barium esophagography, gastroesophageal endoscopy, and biopsy suggested esophageal-related chronic inflammation and ulcer, which probably caused the repeated esophagobronchial fistulas observed. Bronchoscopy revealed a free broncholithiasis in the left main bronchus. The patient was readmitted a fourth time, for the relapse of silicotuberculosis. After 9 months of antituberculous therapy, she was doing well until the recent last follow-up visit.

[Silicotuberculosis]. / La silicotuberculose.

OBJECTIVE: Tuberculosis is a serious and common complication of silicosis. The aim of this study is to describe the epidemiological, clinical, radiological and progressive aspects of this pathological entity. PATIENTS AND METHODS: The study concerns 23 cases of silicotuberculosis which were collected at the service of respiratory diseases at CHU Ibn Rochd of Casablanca, Morocco during 12years (2003-2015). RESULTS: All patients were men. They were 7 diggers, 5 rock crushers, 7 miners and 4 masons. The mean duration of silica exposure was 11years. The symptomatology was dominated by dyspnea and persistent bronchial syndrome. Imagery showed tumor-like opacities in all cases, associated with mediastinal calcified lymphadenopathy in 9 cases, with micronodules in 8 cases and an excavated opacity in 2 cases. The diagnosis of tuberculosis was confirmed by isolation of the Koch's bacillus in sputum in 13% of cases in the bronchial aspirate in 52% and culture in sputum post-bronchoscopy in 13%. The bronchial biopsies confirmed the diagnosis in 2 cases. Tuberculosis had complicated silicosis 9years on average after the cessation of exposure to silica in 65% of cases. The antituberculous treatment was started in all patients with good clinical outcome in 22 cases. We had deplored a case of death by acute respiratory failure. CONCLUSION: Silicosis increases the risk of tuberculosis, hence the importance of TB screening in all patients with silicosis.

[Silicoproteinosis: a specific clinical and radiological entity]. / La silicoprotéinose : une entité radioclinique à part.

INTRODUCTION: Silicoproteinosis is a rare disease, which can cause the rapid onset of respiratory failure following massive exposure to silica dust. CASE REPORT: A 25-year-old patient presented with altered state and dyspnea. The diagnosis of military pulmonary tuberculosis was first considered and antituberculous treatment was started. The diagnosis was reconsidered due to a lack of improvement and the discovery of an 18-month history of exposure to silica. The patient had stopped work 6 months prior to hospitalization. High-resolution CT showed air space condensation associated to centrilobular nodules throughout the lungs and multiple mediastinal lymph nodes, suggesting sarcoidosis. Bronchoalveolar lavage (BAL) suggested the diagnosis of lipoproteinosis. Because of discordance between the bacteriological, radiological and the BAL results, a surgical lung biopsy was performed which led to the diagnoses of a secondary lipoproteinosis. The diagnosis of silicoproteinosis was then considered. Over a one-year follow up, the patient's respiratory failure has progressed markedly despite treatment with corticosteroids. CONCLUSION: Silicoproteinosis is a distinct pathological entity, the diagnosis of which depends on clinical and radiological features as well as BAL findings, which may avoid the need for more invasive investigations.

Silicotuberculosis and silicosis as occupational diseases: report of two cases.

INTRODUCTION: Silicosis, the most prevalent of the pneumoconioses, is caused by inhalation of crystalline silica particles. Silica-exposed workers are at increased risk for tuberculosis and other mycobacterium-related diseases. The risk of a patient with silicosis developing tuberculosis is higher (2.8 to 39 fold higher, depending on the severity of silicosis) than that found in healthy controls. OUTLINE OF CASES: The first patient was a 52-year-old male who was admitted in 2002 for the second time with dyspnoea, wheezing and fatigue over the last 11 years. He had worked in an iron smelting factory and was exposed to silica dust for 20 years. First hospitalization chest radiography showed bilateral pleural adhesions, diffuse lung fibrosis with signs of a specific lung process. Second hospitalization chest radiography showed bilateral massive irregular, non-homogenous calcified changes in the upper and middle parts of lungs. The patient died due to respiratory failure and chronic pulmonary heart in 2007. The main causes of his death were silicotuberculosis and chronic obstructive pulmonary disease. The second patient was a 50-year-old male who was admitted in 2005 for the second time with chest tightness, dyspnoea, wheezing and fatigue over the last 10 years. He had worked in an iron smelting factory and was exposed to silica dust for 30 years. First hospitalization chest radiography showed diffuse lung fibrosis and small nodular opacities. The patient was diagnosed with silicosis, small opacities sized level p/q, and profusion level 2/3. Second hospitalization chest radiography and CT showed diffuse lung fibrosis and small nodular opacities predominantly in the upper lobes. The patient was recognized as having an occupational disease, and received early retirement due to disability. CONCLUSION: In low-income countries, new cases of silicosis and associated lung cancer, chronic obstructive pulmonary disease and tuberculosis are likely to be seen for decades because necessary reduction of silica use will take time to be achieved.

[A case of silicotuberculosis with difficulty in its diagnosis].

A 68-year-old man who had worked as a stone mason for more than 50 years with a heavy smoking history consulted our clinic with symptoms of cough, low grade fever, weightloss, malaise and a single expectoration of hemo-sputum. He had been diagnosed as silicosis by the mass survey 5 years ago based on nodular shadows with egg-shell calcification in hilar lymphnodes on his chest radiography, and has received chest radiographic examination once a year. As the author was not so familiar with the radiographic features of silicotuberculosis, it was difficult to interprete ill-defined contour of silicotic nodules accompanied by patchy opacities formation in right midlung field and silicotic conglomeration accompanied by an ischemic cavity in the left basal segments. A definitive diagnosis could not be established until 10 months later when a second attack of exacerbation of silicotuberculosis occurred showing multiple thin walled fresh tuberculous cavities on the chest radiography with positive smear and culture. Among multiple tuberculous cavities, there was a cirrhotic-walled cavity caused by endogenous reactivation of a quiescent tuberculous lesion on the right apex. This lesion was considered to be the source of dissemination of this case. Finally, it took about two and a half years before establishing the diagnosis in this case because of a series of doctors delays. He was treated successfully with antituberculous drugs for one and a half years including one year rifampicin medication. The clinico-pathological findings of silicotic conglomeration in the left basal segments were discussed based on the findings of transbronchial biopsy from occluded B10 and chest radiographic findings, and it was revealed that silicotic conglomeration might consist of inflammatory granulation combined with granulomatous tubercle, but not a fibrous lesion.

Progressive massive fibrosis in silica-exposed workers. High-resolution computed tomography findings.

OBJECTIVE: To evaluate the radiological characteristics of conglomerate masses using high-resolution computed tomography of the chest. METHODS: From among the patients treated between 1986 and 2004 at the Antonio Pedro University Hospital, 75 patients with silicosis and massive fibrosis, most working in the field of sandblasting, were selected for study. These patients were submitted to a clinical evaluation, chest X-ray and high-resolution computed tomography of the chest. RESULTS: In more than half of the patients with accelerated silicosis, the chest X-ray revealed large type B and C opacities, denoting the severity of the disease in those patients. In 1 case, a unilateral mass simulating lung cancer was observed. High-resolution computed tomography scans of the chest were acquired for 44 patients. In most cases (88.6%), the masses were located in the superior and posterior thirds of the lung. Common findings within the masses included air bronchograms (in 70.4%) and calcifications (in 63.6%). A history of tuberculosis was reported by 52% of the patients. CONCLUSION: In the vast majority of cases, the masses were bilateral, predominantly located in the superior and posterior regions of the lung, featuring air bronchograms and interposed calcifications. Concomitant calcification of the mediastinal and hilar lymph nodes was another common finding. Exposure to high concentrations of dust and having a history of tuberculosis were considered significant risk factors for the development of progressive massive fibrosis.

Silicotuberculosis in the elderly: report of two cases.

Silicotuberculosis is observed rarely in the current clinical practice. We present two patients (a 72-year-old man and a 84-year-old woman) who developed silicosis after having worked for several decades in the ceramics industry. In both, pulmonary tuberculosis complicated the clinical picture several years after retirement. The first subject presented a multicavitary lesion in the apex of the right lung, which subsequently evolved with fibrosis. The other developed bilateral tubercular bronchopneumonia and right tubercular pleurisy, that improved after prolonged antimycobacterial polychemotherapy. The two cases confirm that patients with silicosis are at an increased risk of developing tuberculosis, and show that, nowadays, silicotuberculosis may represent a geriatric problem. In the elderly, recognition of tuberculosis associated with silicosis is often difficult. Occupational history, radiology (conventional chest radiography and computed tomography) and microbiology (identification of Mycobacterium tuberculosis in sputum and pleural exudate) are helpful for the correct diagnosis, which, in turn, is important for prognosis and treatment, as well as in relation to medico-legal issues and occupational-related compensation claims.

Mortality due to silico-tuberculosis and lung cancer among 200 whetstone cutters.

The objective of the present study was to examine if the mortality due to tuberculosis and cancer in the lungs was elevated in a cohort of 200 male whetstone cutters. 1955-1995 death certificate-based mortality data on the cohort were available, and the data were reviewed in the present study for mortality due to the two diseases to calculate standardized mortality ratios (SMR) in reference to the health statistics of Kyoto prefecture, where the cohort lived. Among the 200 cohort members, 99 men deceased during the observation period, the deaths including 10 cases of lung tuberculosis (of which 9 cases had silicosis together), 20 cases of all malignancies, and 6 cases of lung cancer (5 cases with silicosis). There was a significant elevation in the mortality due to lung tuberculosis (SMR = 3.47) although SMR for all causes was not elevated (1.10). There was no significant change in SMR for all malignancies (0.78), whereas SMR for lung cancer (1.24) tended to be elevated although insignificantly. Lung tuberculosis was a significant complication of silicosis in 1955-1995. Possible elevation in lung cancer SMR among this cohort needs further studies.

[Dispensary registration groups and follow-up periods of patients with silicotuberculosis]. / O gruppakh dispansernogo ucheta i srokakh nabliudeniia bol'nykh silikotuberkulezom.

Silicosis is the most common and most frequently tuberculosis-complicated pneumoconiosis with poor prognosis. So a procedure for following up patients with silicotuberculosis requires revision and elaboration. Long-term follow-ups have made it possible to define early signs of this disease and to propose a number of techniques for its early diagnosis, such as chest computed tomography and polarization serum crystal microscopy. Specific recommendations on follow-ups of patients with silicosis and silicotuberculosis by a phthisiologist are laid down.

MRI signal characteristics of progressive massive fibrosis in silicosis.

AIM: To determine the magnetic resonance imaging (MRI) signal characteristics of progressive massive fibrosis (PMF) in silicosis. SUBJECTS AND METHODS: We evaluated prospectively the MR appearances in 17 patients with 34 PMF lesions on the basis of pre-contrast signal intensity (SI) and SI pattern and post-contrast enhancement pattern, using a 0.5-T unit. There were 13 PMF lesions in six patients who had silicosis and 21 PMF lesions in 11 patients who had silicotuberculosis. The SI pattern on T2-weighted image (WI) was classified into four types and the pattern of contrast enhancement on T1-WI was classified into three types. MR appearances of PMF lesions were correlated with the findings of computed tomography (CT). RESULTS: The commonest signal intensity characteristic was isointensity (70%) on T1-WI and hypointensity (68%) on T2-WI when compared with skeletal muscle. For signal pattern on T2-WI, a type with only internal high SI areas (46% in silicosis group, 38% in silicotuberculosis group) was most frequent. All of these areas corresponded to the low density areas at CT, suggestive of necrosis. After intravenous contrast medium enhancement, rim enhancement (54% in silicosis group, 52% in silicotuberculosis group) was most frequent, followed by no enhancement. CONCLUSION: The most common MRI appearance of PMF was isointensity on T1-WI and hypointensity on T2-WI when compared with skeletal muscle, with internal high SI areas on T2-WI and either rim enhancement or no enhancement.

[Efficiency of computed tomography in diagnosis of silicotuberculosis]. / Effektivnost' komp'iuternoi tomografii v diagnostike silikotuberkuleza

The routine methods X-ray study and computed tomography (CT) were compared in a group of patients engaged in fireproof industry. CT yields valuable additional data in early silicotuberculosis, which makes it possible to follow the extent of a silicotuberculous process more completely, to make a better diagnosis of nodal and focal shadows, to identify small decay cavities in the foci and infiltrates. CT is the method of choice in following up patients with silicotuberculosis.

[Ganglio-esophageal fistula revealed by hematemesis: a rare complication of silicotuberculosis]. / Fistule ganglio-oesophagienne révélée par une hématémèse: complication rare d'une silico-tuberculose.

We report a case of fistula between a silicotic mediastinal lymph node and the esophagus with protrusion of a stiff and darkish concretion into the oesophageal lumen. The patient, a 68-year-old coal miner, presented with cough since a few months and the lesion was revealed by haematemesis. The general course was rapidly favourable. Association with tuberculosis was recognized only a few months later.

[Study on X-ray division type of pneumoconiosis-tuberculosis].

By analyzing the chest X-ray films of 805 cases of pneumoconiosis-tuberculosis patients, the authors suggested that the patients could be classified into 6 different types, which were infiltrative, conglomerating, cavitary, destroyed, pleural effusive and blood disseminative types. The principle preventive and therapeutic measures were also recommended. The authors concluded that all these would be helpful for early diagnosis, effective treatment, prognosis evaluation and scientific control of pneumoconiosis-tuberculosis.

[The possibility of using computed tomography in the diagnosis of silicosis and silicotuberculosis]. / K voprosu o vozmozhnosti ispol'zovaniia komp'iuternoi tomograffi v diagnostike silikoza i silikotuberkuleza.

Potentials of computed tomography application to occupational pulmonology are not identified yet, hence it has a limited utility in this sphere. Computed tomography combined with roentgenologic methods serves to specify the origin and size of affected mediastinal nodes, to distinguish between silicotic and silicotuberculotic affects and nodules. Additional data are required.