Coal workers’ pneumoconiosis (CWP) a.k.a. black lung disease and silicosis are two forms of occupational dust disease that give similar imaging appearances but are caused by different pathologic changes within the lungs. Silicosis is the more fibrotic of the two entities and can be an isolated disease process or overlap with, and be part of CWP. Imaging changes in coal workers’ pneumoconiosis begin with the simple type of disease process, in which the interstitial changes appear as small rounded opacities (micronodules), called coal macules, occur in the upper and the middle lung zones. With increasing amounts of coal dust, the complicated type occurs, when progressive massive fibrosis (PMF) a.k.a. “large opacities” develop. Although coal workers’ pneumoconiosis looks like silicosis, the coal macules are more likely to be smaller and less sharply defined, with a lesser likelihood to develop into progressive massive fibrosis (PMF).
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