Silicosis related pleural effusion: black spots in pleura

A male patient in his 70s, who had previously worked as a bricklayer, presented with worsening shortness of breath on exertion and cough for 6 months. He had lost weight, and a respiratory examination suggested a right pleural effusion. Routine evaluation was unremarkable. Sputum examination for tuberculosis was negative; hence, a contrast-enhanced CT of the thorax was performed, which revealed features of silicosis with pleural effusion. Pleural fluid analysis was inconclusive; hence, a medical thoracoscopy was performed, which showed black nodules over the parietal pleura, which were biopsied and showed anthracotic pigmentation with collagenous nodules suggestive of silicosis. A chest drain was inserted, and no further silica exposure was ensured, following which he showed clinicoradiological improvement. In this report, we describe the first case of silicosis presenting with pleural effusion in which the diagnosis was confirmed with medical thoracoscopic pleural biopsy.