Silica exposure causes a spectrum of lung disease ranging from asymptomatic nodules to progressive massive fibrosis and is associated with an increased risk of Mycobacterium tuberculosis infection. Chronic silicosis is the most common silica-related disease and is diagnosed radiographically by nodular interstitial fibrosis, often with “egg-shell” calcified lymphadenopathy. Endobronchial silicotic lesions are rare and occur secondary to local bronchial wall silica-induced fibrosis or broncholithiasis, the endoluminal erosion of peribronchial adenopathy. We present a case of endobronchial silicosis causing the right middle lobe (RML) syndrome. It is significant for the combined presence of mycobacterial tuberculosis infection and absence of radiographic lymphadenopathy, fibrosis, or other features of silica-related disease.