Upper-zone perilymphatic nodules with eggshell-calcified nodes and progressive massive fibrosis (silicosis), and pleural plaques with basal fibrosis (asbestos) — radiographs are classified by the ILO system; CT characterises and finds cancer and TB.
Orient first
- Silicosis: stone cutting, sandblasting, mining, engineered stone; silicotuberculosis is common in India.
- Asbestos-related: pleural plaques (exposure marker), diffuse pleural thickening, asbestosis (fibrosis), mesothelioma and lung cancer.
- The ILO classification standardises radiograph reading for compensation (verify the current revision).
Acquire the study
- High-resolution CT chest, thin sections, prone images.
The manoeuvre
- Lung window: upper-zone perilymphatic and centrilobular nodules (silicosis).
- Conglomerate masses (PMF) with calcification and surrounding emphysema; size in cm.
- Mediastinal nodes with eggshell calcification on soft-tissue window.
- Pleural plaques and basal subpleural fibrosis on prone images (asbestosis).
What confirms it
- A compatible pattern with documented exposure.
What licenses you to exclude it
- A normal HRCT makes clinically significant pneumoconiosis unlikely.
The classic misread
- Missing TB or lung cancer inside PMF — any new cavity or growth needs work-up.