The literature on acute silicosis, or silico-proteinosis, a rare form of silica induced lung disease, was reviewed. Acute silicosis occurred following massive exposures to respirable size particles of silica (7631869) over a short period of time. It was untreatable and invariably fatal. Clinical manifestations included: cough, dyspnea, anorexia, pleuritic chest pain, and weight loss. Acute silicosis was often associated with tuberculosis or other mycobacterial infections. Air bronchograms and an alveolar filling pattern were frequently observed on chest x-rays. Significantly restricted lung volumes commonly occurred, although radiographic findings were variable. Death occurred due to respiratory failure. Histological examination of the lungs revealed large amounts of exudate filling the alveoli, and the presence of epithelium in the alveoli. Sandblasters and silica flour mill workers were at especially high risk of developing acute silicosis. The author concludes that compliance with current exposure standards and continued medical surveillance of exposed workers is essential in the prevention of silicosis.