Chronic Silicosis Presenting With Severe Pulmonary Hypertension And Right Heart Failure: A Case Report Highlighting Late Vascular Complications And Diagnostic Delay.

Abstract

Chronic silicosis is a progressive fibrotic lung disease caused by prolonged inhalation of crystalline silica dust, commonly seen in individuals with occupational exposure such as stone-cutters and miners¹. While pulmonary fibrosis is well recognized, its vascular complications—especially pulmonary hypertension (PH)—are underappreciated and often misdiagnosed as chronic obstructive pulmonary disease (COPD) or idiopathic pulmonary arterial hypertension (IPAH)²˒³. We report a case of a 56-year-old male with a significant occupational history of silica exposure who presented with progressive dyspnea, peripheral edema, and right heart failure. He had been misdiagnosed with COPD for over a year and showed minimal response to inhaled therapies. High-resolution CT of the chest revealed bilateral upper lobe nodular opacities and progressive massive fibrosis, consistent with silicosis². Right heart catheterization confirmed pre-capillary pulmonary hypertension⁴˒⁵. The case underscores the importance of occupational history, imaging, and early screening for vascular complications in fibrotic lung diseases⁶. It also highlights how misdiagnosis may lead to delayed treatment and worsened outcomes. In regions with high silica exposure, clinicians must consider silicosis as a differential diagnosis in patients with unexplained PH or right heart failure⁹. Early recognition and management may improve quality of life and prognosis in such patients.