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Differential diagnosis in silicosis and the importance of an accurate occupational history

Alexandre Franco Amaral1, Anna Miethke-Morais1, Gustavo Faibischew Prado1, Mario Terra-Filho1 and Ubiratan de Paula Santos1
1Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil


Background: Silicosis is a common condition worldwide, and its diagnosis relies upon a thorough occupational history. Nevertheless, there are situations in which images are critical for the diagnosis, such as pulmonary masses, due to lung cancer and tuberculosis risks.

Objective: To report cases of misleading diagnosis in patients with pulmonary masses and occupational exposure to silica.

Methods: We reviewed data on patients with a diagnosis of silicosis in a tertiary hospital, who presented with pulmonary masses and were either submitted to unnecessary procedures, due to lack of information on occupational exposition, or had to be further investigated because of atypical presentations of the disease.

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Two patients presented silicosis with compatible exposure and radiological findings, but had pulmonary masses of unusual locations, which turned out to be lung adenocarcinomas. Three other patients with pulmonary masses and silicosis radiological findings had been submitted to lung resections, including a pneumonectomy, due to the absence of an occupational history. The remaining four had known exposure to silica but, owing to lack of other typical findings of the disease on chest CT, were submitted to biopsies (transthoracic), all of which turned out to be silicosis, and evolved with typical radiological findings.

Conclusions: Silicosis is yet a frequent disease and it should be included in the differential diagnosis of pulmonary masses. The importance of an occupational history and the possibility of a differential diagnosis must be taken into account while evaluating these patients. Pulmonary medical training programs should be aware of this not so rare condition.

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