APIK Journal of Internal Medicine

: 2021  |  Volume : 9  |  Issue : 2  |  Page : 132--133

Radiological diagnosis

Sumati Kulkarni1, Sangram Biradar2,  
1 Department of General Medicine, Basaveshwara Teaching and General Hospital Attached to M R Medical College, Gulbarga, Karnataka, India
2 S B Medical Center, Gulbarga, Karnataka, India

Correspondence Address:
Dr. Sangram Biradar
S B Medical Center, #14, Lahoti Enclave, Station Road, Gulbarga, Karnataka

How to cite this article:
Kulkarni S, Biradar S. Radiological diagnosis.APIK J Int Med 2021;9:132-133

How to cite this URL:
Kulkarni S, Biradar S. Radiological diagnosis. APIK J Int Med [serial online] 2021 [cited 2021 Jul 29 ];9:132-133
Available from: https://www.ajim.in/text.asp?2021/9/2/132/314207

Full Text

A 65-year-old female presented with a complaint of breathlessness since 3 days, which was gradual onset and progressive in nature, the Modified Medical Research Council grade IV, with no positional variation, no history of orthopnea and paroxysmal nocturnal dyspnea, aggravated on exertion, relieved on taking rest, associated with scanty nonproductive cough. She also complains of giddiness, nausea, loss of appetite, and loss of weight. She was hypertensive since 20 years, on regular treatment. The patient had a history of breathlessness on exertion since 15 years. The patient gave a history of working in a glass factory 15 years back with exposure to dust. She had past history of joint pain in both the knees since 10 years. At the time of admission, the patient was maintaining saturation at room air with blood pressure of 140/90 mmHg and pulse rate of 92 beats/min. On inspection, there was decreased chest movements over bilateral mammary areas and on palpation, the chest expansion was reduced to 1 cm. On auscultation, fine crepitations were heard over the mammary, axillary, and infrascapular area. Cardiac, abdominal, and nervous system examination was normal. A chest X-ray [Figure 1] and high-resolution computed tomography (HRCT) thorax [Figure 2] were done.{Figure 1}{Figure 2}


What is the chest x-ray indicative of?What is the most probable diagnosis?What is the differential diagnosis?What is the HRCT thorax suggestive of?

 View Answer


The chest x-ray, [Figure 1] shows multiple nodular opacities, present throughout the lung. They are well-defined and uniform in shape and calcification of nodules is seenThe diagnosis should be focused on the history of exposure to dust followed by which the patient developed symptoms, along with an abnormal chest radiograph which direct us directed toward pneumoconiosis (silicosis or asbestosis)

As India is an endemic country for tuberculosis and there were miliary mottling on chest radiograph, she was suspected as miliary tuberculosis.

The differential diagnosis of miliary pattern on chest x-ray include:

Miliary tuberculosis, healed varicella pneumonia, sarcoidosis, coal workers pneumoconiosis, silicosis, asbestosis, miliary carcinomatosis, disseminated histoplasmosis.

In silicosis, multiple nodular shadows, 2–5 mm in diameter, initially appear in mid and upper zones, eventually involves all lung zones. Whereas, chest X-ray in miliary tuberculosis reveals a miliary reticulonodular pattern (more easily seen on underpenetrated film), although no radiographic abnormality may be evident early in the course and among HIV-infected patients. Other radiological findings include large infiltrates, interstitial infiltrates (especially in HIV-infected patients), and pleural effusion.

The HRCT thorax [Figure 2] shows the evidence of multiple patchy areas of soft-tissue attenuation with air bronchograms and extensive calcific specks with few parenchymal bands. The evidence of diffuse interstitial thickening is noted with large areas of ill-defined consolidation with sub pleural thickening. Ground glass opacities with diffuse interlobular septal thickening are noted. Multiple calcified mediastinal and hilar lymph nodes.

In this case, the HRCT thorax confirmed the diagnosis of silicosis.

Simple silicosis causes multiple, nodular shadows, 2–5 mm in diameter. These initially appear in the mid and upper zones, eventually involving all lung zones but relatively sparing the bases. HRCT not only confirms that they are most profuse in the mid and upper zones but also demonstrates a predilection for the posterior aspect of the lungs not evident on the chest radiograph. The nodules are well defined, uniform in density and size (2–5 mm) and rarely calcify. Linear shadows and septal lines may also appear. In complicated silicosis the nodules become confluent and form homogeneous, nonsegmental areas of shadowing. This tends to occur in the upper lobes, and the areas of fibrosis may migrate toward the hila, creating areas of emphysema in the lung periphery. These changes may be seen on plain radiography but are detected at an earlier stage by HRCT. When complicated silicosis develops, the possibility of tuberculosis should be considered.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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