P – Pneumoconiosis

I – Inflammation infection

N – Neoplasm

E – Edema

S – Sarcoidosis

Pneumoconiosis

Pneumoconiosis represents occupational lung disease caused by the inhalation of various types of industrial dust. Depending on the type of dust, variants of the disease are considered. Many cases have findings that are a combination of reticulations and nodules (reticulo-nodular).

The following mnemonic can be helpful in recalling the types of pneumoconiosis: B-CHAOS.[12]

B – Berylliosis or “benign”

C – Coal worker’s pneumonoconisosis (also known as “black lung”) H – Hard metal disease

A – Asbestosis (clinical, exposure, plaques, bodies)

O – Others: Siderosis (deposition of iron in tissue), talcosis, carbon, aluminosis, kaolin S – Silicosis (from silica dust), stannosis

Case 4.16

Figures 4.50 – 4.52 show bilateral nodules, predominantly in the upper lobes, in a patient diagnosed with coal worker’s disease.

Findings: Multiple dots and lines distributed throughout the lung fields, with a coalesced opacity in the right upper lung field.

Pattern: Interstitial, specifically reticulo-nodular. One can consider the mass differential as well.

Differential Diagnosis: Coal worker’s pneumoconiosis with progressive massive fibrosis (definition, when there is evidence of coalescence of nodules >1 cm). Also consider the PINES mnemonic differential.

Inflammation Infection

Case 4.17

Figures 4.53 and 4.54 is of a 60-year-old HIV-positive male with a CD4 count of 144 cells/mm3 who was complaining of cough, dyspnea, and chest pain [2].

Fig. 4.50 CXR of coal worker’s disease (CWP)

Fig. 4.51 Close-up of same patient