PMC4922280_01
CT axial lung window showing scattered parenchymal opacities (black arrow a), wider parenchymal consolidations in the CT axial lung window (b, black arrow) and mediastinal window (c, black arrow), and CT-guided lung biopsy (needle pointed by black arrow d)
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F1
The computerized tomogram (CT) done 3 months prior to presentation showed nonspecific patchy parenchymal opacities [Figure 1a]. CT (HRCT) of the chest showed bilateral middle and lower lobe ground-glass opacities with left lower lobe consolidation [Figure 1b and c]. CT-guided biopsy of the left lower lobe lesion was performed [Figure 1d] to rule out the possibility of malignancy and histopathological examination showed features of interstitial pneumonia with fibrosis.
(a) Benign squamous cells, pigment laden macrophages and inflammatory cells (Pap, X100) (b) Extensive neutrophilic inflammation (Pap, X100) (c and d) Silica particles appearing as granular birefringent crystals (X200)
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F2
The papanicolaou (PAP) stain on bronchial lavage revealed benign squamous cells, pigment-laden macrophages, and extensive acute inflammatory cell infiltrate [Figure 2a and b]. Detection of numerous birefringent silica particles under polarizing microscope in the bronchial lavage [Figure 2c and d], otherwise not appreciable on PAP stain, clinched the primary diagnosis of silicosis with associated tuberculosis.