Cutting for Stone

Silicosis typically presents with parenchymal lung disease in workers exposed to silica. We present a rare case of isolated pleural and lymph node silicosis without parenchymal involvement in a stone fabrication worker. A 49-year-old man with extensive occupational exposure to stone materials, including engineered stone without consistent use of personal protective equipment, was found to have mediastinal and hilar lymphadenopathy. Initial bronchoscopic and radiology evaluations were nondiagnostic. Video-assisted thoracoscopic surgery revealed pleural nodules, and pathologic examination demonstrated silicotic changes in both pleura and lymph nodes but without parenchymal involvement. This case demonstrates an unusual presentation of silicosis confined to the pleura and lymph nodes, highlighting the importance of thorough evaluation of thoracic pathology in workers with silica exposure. It adds to growing evidence regarding health risks in the engineered stone fabrication industry and emphasizes the need for improved occupational safety measures and medical surveillance.