A 58-year-old former miner with progressive dyspnea has a chest HRCT showing bilateral upper lobe-predominant nodular opacities with eggshell calcification of hilar lymph nodes, and conglomerate masses. Pulmonary function tests show a mixed obstructive-restrictive pattern. Which diagnosis is most consistent?
- A Progressive massive fibrosis (PMF) in silicosis ✓
- B Sarcoidosis stage III
- C Hypersensitivity pneumonitis (farmer's lung)
- D Coal workers' pneumoconiosis (CWP)
Explanation
Progressive massive fibrosis (PMF) is the most advanced form of silicosis, characterized by bilateral upper lobe conglomerate masses (>1 cm), eggshell calcification of lymph nodes (virtually pathognomonic of silicosis), and progressive respiratory failure. PMF occurs when silicotic nodules coalesce and can progress even after cessation of exposure. Coal workers' pneumoconiosis affects predominantly lower lobes. Sarcoidosis has perilymphatic nodules and hilar lymphadenopathy but not typically eggshell calcification. Hypersensitivity pneumonitis lacks eggshell calcifications.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.