Silicosis Epidemic among Engineered Stone Countertop Workers: Pictorial Review

Silicosis, the most common form of pneumoconiosis, results from the inhalation of respirable crystalline silica dust, which is defined as silicon dioxide particles small enough to penetrate lung tissue (<5 μm). Once considered a historical occupational disease primarily affecting miners, silicosis is reemerging among workers who process engineered stone countertops because of the higher silica content of engineered stone compared with natural stone materials (often termed engineered stone pneumoconiosis). The authors discuss imaging features of engineered stone silicosis based on a cohort of patients employed as engineered stone countertop workers in Southern California, one of the largest cohorts in the United States. Historically, silicosis has been described as predominantly chronic silicosis with upper lung-predominant small solid nodules with or without fibrosis, occasional accelerated silicosis, and rarely, acute silicosis. In the engineered stone worker patient cohort described in this article, accelerated silicosis and atypical imaging features at presentation (such as diffuse centrilobular-predominant nodules, superimposed ground-glass opacities, lower lung or cavitary large opacities, and concomitant infections) were more common than expected, which contributed to the initial underdiagnosis and misdiagnosis of silicosis. Furthermore, many patients demonstrated relevant extrapulmonary disease, such as cardiovascular and autoimmune disease. The radiologist plays a pivotal role in recognizing silicosis and including it in their differential diagnosis at patient presentation. Early diagnosis is crucial to prevent further exposure, since silicosis is currently considered incurable. The authors highlight the imaging findings of silicosis to raise awareness among radiologists about this emerging occupational lung disease. ^©RSNA, 2026.