Bilateral Spontaneous Pneumothorax in Chronic Silicosis: A Case Report

Silicosis is an occupational lung disease caused by inhalation of crystalline silica. People working in occupations like sandblasting, surface drilling, tunneling, silica flour milling, ceramic making, and so forth are predisposed to develop silicosis. Crystalline forms of silica are more fibrogenic than the amorphous forms, highlighting the importance of the physical form in pathogenesis. Lung biopsy is rarely performed for the diagnosis of silicosis as it can easily be detected by occupational history and radiological features. Patients with silicosis can develop complications like tuberculosis, lung cancer, progressive massive fibrosis, cor pulmonale, broncholithiasis, or tracheobronchial compression by lymph nodes. Pleural involvement in silicosis is rare. Spontaneous pneumothorax is a pleural complication that can develop in such patients. Usually in silicosis pneumothorax is unilateral. We hereby report the lung biopsy findings and discuss the mechanism of pneumothorax development in a case of chronic silicosis who, later on died during the course of the disease. 1. Introduction Silicosis also known as “potters rot” is a form of pneumoconiosis caused by inhalation of crystalline silica. Crystalline silica is classified as a group 1 substance by the International Agency for Research on Cancer [1]. Currently the most prevalent chronic occupational lung disease in the world, silicosis, usually presents after decades of exposure as a slowly progressing nodular fibrosing pneumoconiosis. Pleural involvement in silicosis is rare and secondary spontaneous pneumothorax is the only described pleural complication [2]. In silicosis, pneumothorax is usually unilateral. We report the occurrence of bilateral spontaneous pneumothorax in a case of chronic silicosis. 2. Case Report A 33-year-old male presented with progressive breathlessness and dry cough since the last 5 months and right sided pleuritic chest pain for 10 days. Patient was diagnosed elsewhere as miliary tuberculosis and was under antitubercular treatment (ATT) for four months. He was not a smoker. He worked as a bore-well driller for the past 10 years. Blood hemogram and renal and liver functions were normal. Admission chest radiograph showed bilateral, diffuse, well-defined large rounded nodular opacities with right secondary spontaneous pneumothorax (Figure 1). Figure 1: Chest X-ray: bilateral diffuse nodular opacities with bilateral pneumothorax. Patient was managed with tube thoracostomy, supplemental oxygen, and analgesics. After three days patient complained of acute onset chest pain on left