Silicosis presenting with simultaneous bilateral spontaneous pneumothorax

Abstract

Secondary unilateral spontaneous pneumothorax can occur in a silicosis patient. We are reporting a case of bilateral simultaneous pneumothorax in a silicosis patient.

Keywords: Pneumothorax, Bilateral, Silicosis

How to cite this article:
Bairagya TD, Jana PK, Das SK, Bhattacharaya S, Dhua A. Silicosis presenting with simultaneous bilateral spontaneous pneumothorax. Ann Trop Med Public Health 2012;5:528-9
How to cite this URL:
Bairagya TD, Jana PK, Das SK, Bhattacharaya S, Dhua A. Silicosis presenting with simultaneous bilateral spontaneous pneumothorax. Ann Trop Med Public Health [serial online] 2012 [cited 2020 Apr 18];5:528-9. Available from: https://www.atmph.org/text.asp?2012/5/5/528/105154
Introduction

Pleural involvement in silicosis is rare. The only recognized pleural complication of silicosis is pneumothorax which is usually unilateral. It occurs late in the course of chronic silicosis and may prove a fatal complication. [1] We report a patient who presented with bilateral simultaneous spontaneous pneumothorax due to silicosis which developed within a period of 10 years of silica exposure.

Case Report

A 21 years old male patient presented with increased shortness of breath for one day along with non-productive cough. He has history of exertional dyspnea from the past 4 years. The patient denied history of fever, haemoptysis, joint pain and skin rashes. He was a smoker for three years and used to smoke 10 cigarettes per day. There was no history of anti-tuberculosis treatment or contact with tuberculosis. On enquiry regarding occupational history there was history of exposure to silicon dust for 10 years in a stone cutting factory. On examination he was thin built person, central cyanosis with tachycardia was present. Respiratory system examination revealed bilateral hyper resonant note on percussion with diminished vesicular breath sound. Sao 2-86%, ECG- revealed tachycardia, blood picture was normal except raised ESR. Emergency chest X ray (PA View) bilateral pneumothorax with evidence of bilateral parenchymal lesion within the collapsed lung [Figure 1] HRCT scan thorax also done [Figure 2] showed bilateral pneumothorax along with both interstitial and parenchymal infiltrate. Sputum for Mycobacterium tuberculosis (A.F.B) was negative. Tube thoracostomy with water seal drainage done in both side. Pleurodesis with 10% povidone iodine done sequentially. On follow up there were no recurrences during two years period.

Figure 1: Chest X ray (PA) showing bilateral pneumothorax with non homogenous opacity in both lung parenchymas

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Figure 2: CT scan thorax showing bilateral pneumothorax along with both interstitial and parenchymal infiltrate

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Discussion

Silicosis is caused by inhalation of dust containing crystalline silicon dioxide which commonly occurs in workers involved in quarrying, stone cutting, mining, tunneling, foundry-work, ceramics. The pathogenicity pathogen of silica dust is dependent on the physical/mechanical and chemical properties of the particles. An excellent review of this topic summarizes the processes whereby silica produces inflammation and fibro genesis in the lung. [2] Chronic silicosis, the commonest form, occurring after many years of exposure to relatively low levels of dust. It is characterized by progressive dyspnea and radiological features of progressive massive fibrosis. Less common complications include cor-pulmonale, spontaneous pneumothorax, broncholithiasis, and tracheobronchial obstruction in the neighborhood of enlarged calcified hilar nodes. [3] Diagnosis of active tuberculosis in the silicotic patient may be more difficult than in the non-silicotic patient, but in general a good sample of sputum or sputum induced by nebulized hypertonic saline, sent for mycobacterial culture, provides the diagnosis. The presence of cough, hemoptysis, weight loss, fever, or any new radiologic feature should be pursued with culture of sputum or BAL fluid or with culture and histologic examination of tissue. In many instances, it is the chest radiograph rather than clinical features that gives the first indication of tuberculosis in the presence of silicosis, but it should be noted that patients with silicosis are also at risk for extra pulmonary tuberculosis. [4] Pneumothorax is a rare event in the course of silicosis and is usually unilateral. [5] It is more commonly seen in chronic silicosis having progressive massive fibrosis. It is quite rare event in acute silicosis. The patients of silicosis who develop sudden onset of dyspnea should be promptly investigated for this complication.

References
1. Rao S, Rau PV. Bilateral spontaneous pneumothorax in silicosis. Indian J Chest Dis Allied Sci 1993;35:47-9.
2. Mossman BT, Churg A. Mechanisms in the pathogenesis of asbestosis and silicosis. Am J Respir Crit Care Med 1998;157:1666-80.
3. Ziskind M, Jones RN, Weill H. Silicosis. Am Rev Respir Dis 1976;113:643-65.
4. Cowie RL. The epidemiology of tuberculosis in gold miners with ­silicosis. Am J Respir Crit Care Med 1994;150:1460-2.
5. Suratt PM, Winn WC Jr, Brody AR, Bolton WK, Giles RD. Acute ­silicosis in tombstone sandblasters. Am Rev Respir Dis 1977;115:521-9.

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/1755-6783.105154

Figures

[Figure 1], [Figure 2]

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