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Intra-Abdominal Egg-Shell Calcifications Due to Silicosis

1956; Radiological Society of North America; Volume: 67; Issue: 4 Linguagem: Inglês

10.1148/67.4.527

1527-1315

Lewis Jacobs, B. Gerstl, A. Gerson Hollander, Michael Berk,

Parathyroid Disorders and Treatments

Intra-abdominal egg-shell calcifications due to silicosis are extremely rare. In a fairly extensive review of the literature only 1 case, reported by Riemer (5), was found. The case to be presented here is an example of extreme egg-shell calcification in the peri-aortic abdominal lymph nodes, unique in our experience. Of 41 patients at the Oakland Veterans Administration Hospital with a clinical diagnosis of pulmonary silicosis, 10 showed intrathoracic egg-shell calcification of varying degree, and 5 intra-abdominal calcification. In 3 of the latter, the calcification was of the mulberry type; 1 was of a rather indefinite amorphous character, and 1 was of the eggshell variety. In 17 cases no x-ray examination of the abdomen had been made. An additional 50 cases were listed in the x-ray cross index under silicosis, either for diagnostic or differential purposes. Nineteen of these patients were found not to have silicosis, and in 12 records were not available for review. Of the remaining 19, thoracic egg-shell calcifications were found in 3, abdominal in none. Case Report A 63-year-old white male was admitted for treatment of cardiac failure and chronic bronchitis on Sept. 27, 1954. He had been hospitalized in 1948 for Buerger's disease with Raynaud's phenomenon, which had been relieved by a bilateral cervical sympathectomy. The chief complaint on the present admission was a persistent cough, productive of about half a cup of yellowish or whitish sputum a day, with no blood, and occasional wheezing. For the past six months the patient had been dyspneic on exertion; lately he had become orthopneic. He complained also of fatigability, weakness, anorexia, and a weight loss of 15 pounds. One week before hospitalization he began to have edema of the feet, which improved following digitalization under the direction of his private physician. The patient had been a hard-rock miner from 1911 to 1917, and subsequently an electrician. There was no history of exposure to Echinococcus. A chest roentgenogram in 1932 was reported as showing pneumoconiosis and chronic bronchitis. One taken in 1948 demonstrated a diffuse, somewhat nodular increase of lung markings with peripheral calcifications, both nodular and egg-shell in type, with eggshell hilar calcifications. Physical examination revealed moderate dyspnea and orthopnea at rest. There was a 2-plus edema of the lower extremities. The neck veins were distended. Blood pressure was 170/80, pulse rate 90, and weight 134 pounds (average weight had been 150). The eyegrounds showed moderate sclerotic changes. The heart was slightly increased in size, with occasional ectopic beats and tones of good qualify. P-2 was accentuated and there was a Grade II blowing systolic murmur at the apex. The liver was moderately tender and extended two finger breadths below the costal margin. The dor-salis pedis pulses were not palpable. Bilateral Dupuytren's contractures were observed.