A rare case of anthracofibrosis complicated with pulmonary embolism

We present a case of anthracofibrosis with a challenging diagnostic approach, complicated with pulmonary embolism (PE). A coal exposed 71-year-old woman presented with acute respiratory failure. Lung cancer was suspected, as computed tomography (CT) findings included a mass. Apart from mild stenosis of the RUL bronchus, bronchoscopy failed to reveal significant endobronchial findings, while biopsy and cytology were negative for malignancy. Fine needle aspiration (FNA) was performed, leading to the diagnosis of anthracosis, based on the new cytologic findings which included soot particles. Although bronchoscopy is the gold standard, pigmented lesions or bronchial stenosis were not detected. Moreover, during her hospitalization the patient also presented aggravating respiratory failure and CT pulmonary angiography (CTPA) showed PE. There have been reports that anthracofibrosis might generate a hypercoagulant state. The pathophysiological mechanisms that explain this occurrence are presented in this case report.