Progressive massive fibrosis is the coalescence of fibrotic lung tissue into large masses. Severe lymphadenopathy and fibrosis can lead to mass effect and compression of thoracic structures. The anteroposterior radiograph of the chest demonstrates a tortuous trachea with rightward deviation. Computed tomography of the chest shows multifocal areas of fibrosis. A mass of fibrotic tissue and lymph nodes causes tracheal deviation and compresses the esophagus (red arrow). Pulmonary bronchoscopy was negative for infectious pathogens and was consistent with a fibrotic inflammatory process. The patient revealed that he had a 21 year old relative who died of “lung problems” after working the same job as a well digger.
Progressive massive fibrosis is a chronic progression and complication of pneumoconiosis. Large masses of fibrotic tissues and enlarged lymph nodes can lead to dysphagia and dyspnea through compression of esophagus and airway structures.