Egg-Shell Calcifications

Egg- shell calcifications A man in his late fifties presented to us with dry cough and gradually progressive shortness of breath for 5 years, with breathlessness at rest for the last 6 months. There was no history of fever, chest pain, hemoptysis, loss of appetite, weight or connective tissue disease features. He has not been working for the last 5 years before which he worked in a cast making factory for 20 years with history of silica exposure. There was pandigital grade 3 clubbing. Chest auscultation revealed bilateral diffuse fine inspiratory crepitations. His chest radiograph showed bilateral diffuse non homogenous opacities with upper zone predominance, bilateral volume loss, mediastinal and hilar calcifications (Panel A). We performed contrast enhanced computed tomography (CECT) chest which revealed bilateral upper lobe dense fibrotic lesions representing progressive massive fibrosis, with areas of cavitation and calcification within. In addition, bilateral diffuse nodular opacities, mediastinal and hilar lymph node calcifications were seen (Panel B, C, D). The pattern of calcification was the classical ‘eggshell calcification’, with a calcified rim around the periphery of the lymph nodes.