Progressive Massive Fibrosis with Angel’s Wing Appearance on Chest Radiograph

A woman in her eighties presented with a persistent cough of over 20 years’ duration. Her medical history included treatment for pulmonary tuberculosis 30 years prior and a history of decades-long exposure to silica dust in her youth. Chest radiography revealed bilateral radiopacities in a parahilar location, resulting in an ‘angel’s wing’ appearance Figure 1a. Computed tomography (CT) of the thorax confirmed the presence of numerous calcified nodules throughout the lungs, as well as calcified mediastinal and hilar lymph nodes. Bilateral conglomerate masses with volume loss in the upper lobes were also noted, indicative of progressive massive fibrosis (PMF) Figure 1b.Figure 1: (a) Chest radiograph revealed bilateral radiopacities in a parahilar location, giving rise to the angel’s wing appearance. (b) Computed tomography of the thorax showing multiple calcified nodules throughout the lungs and conglomerate masses with volume loss at the bilateral upper lobes.PMF is a severe form of chronic pneumoconiosis caused by prolonged exposure to silica dust and is characterised by the coalescence of silicotic nodules into larger masses. PMF is defined pathologically as parenchymal lesions larger than 2cm in diameter, most commonly found in the upper posterior portions of the lungs. These lesions can obstruct blood vessels and bronchioles, leading to respiratory failure and hypoxia. PMF has been shown to be associated with an increased risk of tuberculosis or atypical mycobacterial infections.1,2 Yucesoy et al.3 found that genetic susceptibility may play a role in the development of PMF in coal miners. Another study by Sari et al.2 analysed the CT findings in 90 cases of PMF and found that the majority of patients had extensive bilateral lung involvement and lung volume loss. In addition, a study by Sester et al.4 found that occupational exposure to silica dust can increase the risk of systemic autoimmune diseases such as rheumatoid arthritis, systemic lupus erythematosus and Sjogren’s syndrome. Furthermore, evidence suggests that silicosis may be associated with an increased risk of cardiovascular disease.5 In conclusion, this case highlights the devastating effects of prolonged exposure to silica dust and underscores the importance of workplace safety measures and regular monitoring of workers exposed to such dust. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.