Biapical Scarring: Causes, Associated Conditions & Clinical Significance

Biapical scarring = fibrosis at both lung apices. Usually an incidental imaging finding (CXR, CT).

Associated Conditions

• Sarcoidosis: Classic association (stage II/III).
• Tuberculosis (prior): Healed apical TB (Simon foci).
• Fungal infections: Histoplasmosis, coccidioidomycosis, cryptococcosis, aspergillosis.
• Radiation fibrosis: Prior thoracic radiotherapy.
• Ankylosing spondylitis: Apical fibrosis (rare).
• Silicosis/coal worker's pneumoconiosis.
• Idiopathic: No identifiable cause.

Clinical Approach

• Correlate with history, symptoms, labs (ACE, TB testing, serologies).
• Stable, asymptomatic, bilateral symmetric scarring often benign sequelae.
• Progressive/unilateral/new symptoms → investigate for malignancy, active infection, sarcoid flare.

Pulmonary function tests may show restriction. Follow-up imaging per clinical context.