The case history is reported of a former coal-miner who, on admission to hospital with acute bronchitis, was found to have a chest radiograph suggestive of pneumoconiosis. However, the film taken on leaving the mines some four years previously was unremarkable, suggesting that the disease had either started or progressed during his four years away from the mines. Among the alternative explanations considered is the possibility that the diagnosis was in error and that the appearance was due to some radiologically similar disease which had chanced to affect an ex-miner. Some of the technical pitfalls inseparable from reliance on radiology are also mentioned as the appearance of progression may have been illusory. Other possibilities are that the disease was not the simple pneumoconiosis of coal-workers but some other form of pneumoconiosis, such as Caplan's syndrome or silicosis, in both of which the natural course of the illness may be quite different. Nevertheless, although it is clear that coal-workers' pneumoconiosis does not normally progress once the subject is removed from the mines, the possibility remains that in a small number of cases it may do so.
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