10-9 DSA - Pneumoconiosis by Kinder Flashcards
What is silicosis?
a fibrotic lung disease caused by the inhalation of crystalline silica usually in the form of quartz.
In what industries are workers at risk for developing silicosis?
Industries at risk: mining, tunneling, excavating, quarrying, stonework, foundries, sandblasting, ceramics, and recently stressed denim jean manufacturing – sandblasting
What are the presentations of silicosis?
Chronic silicosis
accelerated silicosis
acute silicosis
progressive massive fibrosis
What is the pathology associated with chronic silicosis? What are the patient complaints?
Hallmark pathology is the silicotic nodule characterized by whorled hyalinized collagen fibers with a more peripheral zone of dust laden macrophages.
Patients may be asymptomatic or complain of dyspnea. Productive cough is common.
When does chronic silicosis occur?
Chronic silicosis: most common form of the disease. Usually occurs 20 years or more after the exposure.
When does accelerated silicosis occur? What is the clinical course?
Accelerated silicosis:
Nodules develop after 3-10 years of exposure.
Clinical course is progressive.
When does acute silicosis appear?
Acute silicosis (silicoproteinosis):
develops in 6 months to 2 years after massive exposure
What are the symptoms of acute silicosis? What does the pathology point to?
Symptoms include dyspnea, cough, and weight loss that rapidly progress to respiratory failure and death.
Pathology consistent with an alveolar filling process.
What size and where are the lesions associated with progressive massive fibrosis?
Progressive massive fibrosis:
lesions are at least 1cm in diameter, often larger
usually involve the upper lobes.
What does progressive massive fibrosis lead to?
Leads to respiratory failure, cor pulmonale, weight loss, and death.
What are the diseases associated with silicosis?
Tuberculosis: silicosis patients are at increased risk for developing Tb.
COPD and Chronic Bronchitis: increased incidence in silicosis patients
Collagen Vascular Disease: rheumatoid arthritis and scleroderma are increased with silicosis.
Lung Cancer: risk increased
How does silicosis present on CXR?
symmetric nodular pattern involving the upper lobes.
Hilar adenopathy with eggshell calcification is strongly suggestive. Progressive massive fibrosis is characterized by coalescence of the nodules with larger mass lesions.
Acute silicosis displays air space and interstitial pattern on x-ray
What do PFTs show in silicosis?
normal early in chronic silicosis,
later mixed pattern of obstruction and restriction
How is silicosis dx’ed?
Based on history of exposure and characteristic x-ray changes
How is silicosis managed?
Disease is irreversible.
Avoid further exposure.
Tb testing.
Smoking cessation.
Consider lung transplants in acute and accelerated silicosis.
What is Coal Worker’s pneumoconiosis? What causes it, and what increases risk?
fibrosis results from the deposit of coal dust in the lung.
Risk increases with intensity of exposure and carbon content.
Anthracite is most toxic.
What are the risk factors for coal worker’s pneumoconiosis?
underground miners at more risk than surface miners.
What is the pathology behind coal worker’s pneumoconiosis?
coal macule consisting of macrophages laden with coal dust within the walls of respiratory bronchioles and adjacent alveoli.
Coal nodules.
Progressive massive fibrosis may be seen.
What is the clinical presentation of coal worker’s pneumoconiosis?
usually no symptoms or signs.
Can have symptoms of bronchitis.
May lead to progressive massive fibrosis.
What diseases are associated with coal worker’s pneumoconiosis?
Silicosis is also common in coal workers
Scleroderma, rheumatoid nodules increased
Caplan Syndrome: rheumatoid arthritis with large cavitary pulmonary nodules associated with silicosis and coal worker’s pneumoconiosis.
TB not increased unless associated silicosis
Lung Cancer not increased
What is found on CXR in coal worker’s pneumoconiosis?
resembles silicosis.
Small rounded opacities in the lung parenchyma.
Can progress to PMF with nodules from 0.5 to 5 cm
What is seen in PFTs with coal worker’s pneumoconiosis?
normal in early phase, often obstructive later on, but may show restriction if pulmonary fibrosis present.
Coal dust has been shown to cause emphysema
How is coal worker’s pneumoconiosis dx’ed?
coal dust exposure, chest x-ray
How is coal dust pneumoconiosis managed?
avoid exposure, stop smoking
What is asbestosis? How long between exposure and disease?
Chronic fibrotic interstitial lung disease secondary to prolonged inhalation of asbestos fibers.
Twenty year latency between disease and exposure is common.
What industries have workers at risk for developing asbestosis?
mining, milling, and transportation of asbestos, building demolition, brake lining, shipbuilding, insulations, fireproofing.
Asbestos use in construction was banned in the 1980’s.
What is a common pathological finding with asbestosis?
ferruginous bodies, asbestos bodies can be found in sputum or BAL fluid
What are the signs and symptoms of asbestosis?
Symptoms: dyspnea, dry cough, chest tightness/pain
Signs: inspiratory basal crackles, clubbing
What are the diseases associated with asbestosis?
Mesothelioma: has 30-40 year latency, is incurable, and has 9-18 month survival.
Lung cancer: risk is 4-6 times higher
Pleural Effusion: usually small, exudative, blood stained, and contains leukocytes. Most clear spontaneously.
What findings on CXR are consistent with asbestosis?
pleural plaques, pleural effusion with latency of 10-15 years, pleural thickening, and rounded atelectasis with “comet tail”, lower lobe and subpleural disease are prominent
What do PFTs show in asbestosis?
restrictive pattern, but may see obstruction
What 6 things are needed to dx asbestosis?
1) reliable history of asbestos exposure
2) appropriate lag time between exposure and disease
3) lung fibrosis on chest x-ray or CT
4) restrictive PFT
5) bilateral inspiratory crackles
6) clubbing of fingers or toes
Exposure and x-ray essential, others confirmatory
How is asbestosis managed?
No effective treatment. Avoid exposure. Stop smoking. Lung transplant
What industries have workers at risk for developing beryllium disease?
aerospace, electronics, ceramics, metal, nuclear, telecommunications, tool and die, welding
What are the clinical presentations of beryllium disease?
acute toxic pneumonitis
chronic beryllium disease
What causes acute toxic pneumonitis? What are the signs and symptoms?
Acute Toxic Pneumonitis:
high exposure can lead to a hypersensitivity response that is now rare due to better recognition of beryllium associated disease.
Symptoms include cough and chest pain.
Signs include blood-tinged sputum and crackles.
What does chronic beryllium disease resemble? When is time of onset?
Chronic beryllium disease:
clinical features are similar to sarcoidosis ranging from asymptomatic to severe granulomatous restrictive lung disease.
Onset is 20 years or more after exposure.
An inquiry into possible beryllium exposure must be made in all potential sarcoidosis patients.
What are the signs and symptoms of beryllium disease?
Symptoms can include dyspnea, cough, chest pain, weight loss, fatigue, and arthralgias.
Signs may include crackles.
What does CXR show with beryllium disease?
enlarged hilar or mediastinal lymph nodes, or multiple lung nodules, or both. In later stages patchy fibrosis, hyperinflation, and honeycombing.
What do PFTs show in beryllium disease?
restriction
How is beryllium disease dx’ed?
documented exposure to beryllium, evidence of lung disease
and
positive BeLPT( beryllium lymphocyte proliferation test) performed on blood or BAL fluid
How is beryllium disease managed?
avoid further exposure, stop smoking, steroids
