A 57-Year-Old Man With Persistent Miliary Pattern Pulmonary Nodules and New Lung Masses on Chest CT Scan

Area of Science:

• Pulmonary Medicine
• Occupational Health
• Radiology

Background:

• A 57-year-old male presented with a 6-year history of progressive cough, dyspnea, and wheezing.
• Symptoms persisted despite treatment for presumed asthma, including budesonide and oxygen therapy.

Observation:

• The patient had a 27-pack-year smoking history, quitting 10 years prior.
• He reported 17 years of occupational exposure to polished granite, quartz, and artificial marble in Israel.
• Previous workups revealed multiple, stable pulmonary nodules and mediastinal adenopathy on CT scans over 6 years.

Findings:

• Chest CT scans demonstrated chronic pulmonary architectural alterations and numerous pulmonary nodules.
• Mediastinal adenopathy was also noted on imaging.
• The patient's symptoms were refractory to asthma treatment.

Implications:

• This case highlights the importance of considering occupational exposures in the differential diagnosis of interstitial lung diseases.
• Prolonged exposure to silica-containing materials may lead to chronic pulmonary changes and nodule formation.
• Further investigation into the specific nature of the occupational exposure and its long-term pulmonary effects is warranted.