10-9 DSA - Pneumoconiosis by Kinder

Question 1

What is silicosis?

Answer 1

a fibrotic lung disease caused by the inhalation of crystalline silica usually in the form of quartz.

Question 2

In what industries are workers at risk for developing silicosis?

Answer 2

Industries at risk: mining, tunneling, excavating, quarrying, stonework, foundries, sandblasting, ceramics, and recently stressed denim jean manufacturing – sandblasting

Question 3

What are the presentations of silicosis?

Answer 3

Chronic silicosis

accelerated silicosis

acute silicosis

progressive massive fibrosis

Question 4

What is the pathology associated with chronic silicosis? What are the patient complaints?

Answer 4

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.

Question 5

When does chronic silicosis occur?

Answer 5

Chronic silicosis: most common form of the disease. Usually occurs 20 years or more after the exposure.

Question 6

When does accelerated silicosis occur? What is the clinical course?

Answer 6

Accelerated silicosis:

Nodules develop after 3-10 years of exposure.

Clinical course is progressive.

Question 7

When does acute silicosis appear?

Answer 7

Acute silicosis (silicoproteinosis):

develops in 6 months to 2 years after massive exposure

Question 8

What are the symptoms of acute silicosis? What does the pathology point to?

Answer 8

Symptoms include dyspnea, cough, and weight loss that rapidly progress to respiratory failure and death.

Pathology consistent with an alveolar filling process.

Question 9

What size and where are the lesions associated with progressive massive fibrosis?

Answer 9

Progressive massive fibrosis:

lesions are at least 1cm in diameter, often larger

usually involve the upper lobes.

Question 10

What does progressive massive fibrosis lead to?

Answer 10

Leads to respiratory failure, cor pulmonale, weight loss, and death.

Question 11

What are the diseases associated with silicosis?

Answer 11

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

Question 12

How does silicosis present on CXR?

Answer 12

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

Question 13

What do PFTs show in silicosis?

Answer 13

normal early in chronic silicosis,

later mixed pattern of obstruction and restriction

Question 14

How is silicosis dx’ed?

Answer 14

Based on history of exposure and characteristic x-ray changes

Question 15

How is silicosis managed?

Answer 15

Disease is irreversible.

Avoid further exposure.

Tb testing.

Smoking cessation.

Consider lung transplants in acute and accelerated silicosis.

Question 16

What is Coal Worker’s pneumoconiosis? What causes it, and what increases risk?

Answer 16

fibrosis results from the deposit of coal dust in the lung.

Risk increases with intensity of exposure and carbon content.

Anthracite is most toxic.

Question 17

What are the risk factors for coal worker’s pneumoconiosis?

Answer 17

underground miners at more risk than surface miners.

Question 18

What is the pathology behind coal worker’s pneumoconiosis?

Answer 18

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.

Question 19

What is the clinical presentation of coal worker’s pneumoconiosis?

Answer 19

usually no symptoms or signs.

Can have symptoms of bronchitis.

May lead to progressive massive fibrosis.

Question 20

What diseases are associated with coal worker’s pneumoconiosis?

Answer 20

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

Question 21

What is found on CXR in coal worker’s pneumoconiosis?

Answer 21

resembles silicosis.

Small rounded opacities in the lung parenchyma.

Can progress to PMF with nodules from 0.5 to 5 cm

Question 22

What is seen in PFTs with coal worker’s pneumoconiosis?

Answer 22

normal in early phase, often obstructive later on, but may show restriction if pulmonary fibrosis present.

Coal dust has been shown to cause emphysema

Question 23

How is coal worker’s pneumoconiosis dx’ed?

Answer 23

coal dust exposure, chest x-ray

Question 24

How is coal dust pneumoconiosis managed?

Answer 24

avoid exposure, stop smoking

Question 25

What is asbestosis? How long between exposure and disease?

Answer 25

Chronic fibrotic interstitial lung disease secondary to prolonged inhalation of asbestos fibers.

Twenty year latency between disease and exposure is common.

Question 26

What industries have workers at risk for developing asbestosis?

Answer 26

mining, milling, and transportation of asbestos, building demolition, brake lining, shipbuilding, insulations, fireproofing.

Asbestos use in construction was banned in the 1980’s.

Question 27

What is a common pathological finding with asbestosis?

Answer 27

ferruginous bodies, asbestos bodies can be found in sputum or BAL fluid

Question 28

What are the signs and symptoms of asbestosis?

Answer 28

Symptoms: dyspnea, dry cough, chest tightness/pain

Signs: inspiratory basal crackles, clubbing

Question 29

What are the diseases associated with asbestosis?

Answer 29

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.

Question 30

What findings on CXR are consistent with asbestosis?

Answer 30

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

Question 31

What do PFTs show in asbestosis?

Answer 31

restrictive pattern, but may see obstruction

Question 32

What 6 things are needed to dx asbestosis?

Answer 32

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

Question 33

How is asbestosis managed?

Answer 33

No effective treatment. Avoid exposure. Stop smoking. Lung transplant

Question 34

What industries have workers at risk for developing beryllium disease?

Answer 34

aerospace, electronics, ceramics, metal, nuclear, telecommunications, tool and die, welding

Question 35

What are the clinical presentations of beryllium disease?

Answer 35

acute toxic pneumonitis

chronic beryllium disease

Question 36

What causes acute toxic pneumonitis? What are the signs and symptoms?

Answer 36

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.

Question 37

What does chronic beryllium disease resemble? When is time of onset?

Answer 37

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.

Question 38

What are the signs and symptoms of beryllium disease?

Answer 38

Symptoms can include dyspnea, cough, chest pain, weight loss, fatigue, and arthralgias.

Signs may include crackles.

Question 39

What does CXR show with beryllium disease?

Answer 39

enlarged hilar or mediastinal lymph nodes, or multiple lung nodules, or both. In later stages patchy fibrosis, hyperinflation, and honeycombing.

Question 40

What do PFTs show in beryllium disease?

Answer 40

restriction

Question 41

How is beryllium disease dx’ed?

Answer 41

documented exposure to beryllium, evidence of lung disease

and

positive BeLPT( beryllium lymphocyte proliferation test) performed on blood or BAL fluid

Question 42

How is beryllium disease managed?

Answer 42

avoid further exposure, stop smoking, steroids