Chest
Volume 112, Issue 5, November 1997, Pages 1436-1438
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Selected Reports
Silica-Induced Pleural Disease: An Unusual Case Mimicking Malignant Mesothelioma

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A 57-year-old man with a history of exposure to silica for 32 years presented with pleural thickening of the lower lobe of the left lung and a chronic right-sided pleural effusion without any radiographic evidence of parenchymal nodules in either lung. Light microscopic examination of a left visceral pleural biopsy specimen revealed markedly thickened pleura with fibrosis and macrophages containing birefringent silica and silicates. Occasional rounded intrapleural silicotic nodules were present. The underlying lung tissue did not show fibrosis or silicotic nodules. An energy-dispersive x-ray analysis confirmed the presence of silica. In the absence of lung involvement, this case represents a very unusual pathologic reaction caused by silica and silicates and adds to the clinical differential diagnosis of chronic pleuritis and malignant mesothelioma.

Section snippets

CASE REPORT

A 57-year-old man presented with chest pain, shortness of breath, and fever. He had a 32-year history of exposure to silica and silicates in a plumbing fixture factory where he sprayed glazing compound (primarily comprised of clay) onto the fixtures prior to their being fired. The patient was required to a wear a mask. He described airborne dust resulting from the spraying process itself and from the sweeping up of the dried glazing compound that had fallen on the floor. The chest radiographs

COMMENTARY

Involvement of the pleura in pulmonary silicosis is well-described.1 In advanced cases of silicosis, the pleural surfaces of the lungs are fibrotic with typical silicotic nodules and rarely diffuse plaques.1 Typically, there are multiple white spherical silicotic nodules protruding from the surface of the pleura.6 Al-Kassimi7 reported a case of lung silicosis with pleural effusion. In his case, no pathologic changes in the pleura other than mesothelial cell hyperplasia were noted.

Extrapulmonary

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