This 83 year old man presented with weight loss to a lung cancer clinic in mid 2003.
Nodules were seen on his chest X-ray (Image A) in the right upper zone (normal Chest X-ray in 1998), and the upper most one resected. Pulmonary function showed normal values apart from reduced diffusion (DLCO of 60% predicted) and a resting pO2 of 62 mmHg (8.3 kPa). The lung was almost black from carbon deposit. Histology showed a central abscess with septate, branching hyphae in the necrotic area, with surrounding fibrosis and granulomas. The lung contained multiple carbon particles (anthracosis) and coal fly ash. Cultures of the lesion were not done. His Aspergillus fumigatus precipitins were negative and postoperatively his C-reactive protein was <5mg/L.
Images B,C,F. CT scan of the thorax pre-operatively showing extensive fine interstitial infiltrates, consistent with exposure to coal dust, together with emphysema.
Images D,E. CT scan of the thorax pre-operatively through the most apical nodule (1x2cm) showing spiculation and some evidence of cavitation/necrosis in its centre.