Diagnosing Pleural Effusion Caused by Silicosis in a Long-Term Quarry Worker: A Case Report

Patients affected by silicosis often exhibit clinical symptoms such as dyspnea, chronic cough, sputum production, hemoptysis, and chest pain. Common complications of silicosis include pulmonary tuberculosis, right-sided heart failure, emphysema, and lung cancer. Some of these complications can cause pleural effusion, however, reports that clearly attribute pleural effusion directly to silicosis are uncommon. We report a case of pleural effusion directly caused by silicosis, confirmed by thoracoscopic pleural biopsy and polarized microscopy.

We report a case of a 78-year-old man with a history of working in a quarry for over 10 years. He was admitted to our hospital twice due to chest tightness and dyspnea. Both chest computed tomography (CT) scans indicated multiple nodular changes in the lungs, with predominantly right-sided pleural effusion. The results of pleural fluid tests were consistent with exudative effusion. Pleural biopsy specimens obtained by thoracoscopy showed silica particles under polarized light microscopy. Additional tests ruled out heart failure, tumors, and other causes of pleural effusion, based on which a final diagnosis of pleural effusion due to silicosis was made.

This case provides histological proof that silicosis can directly involve the pleura and cause exudative effusion. Furthermore, it highlights the diagnostic value of thoracoscopic pleural biopsy with polarized microscopy in silica-exposed patients with unexplained pleural effusion.