Interstitial Lung diseases, Part II, D Kinder, DSA Flashcards
Silicosis
fibrotic lung disease caused by inhalation of crystalline silica in form of quartz
What industries are at risk for silicosis
mining, tunneling, excavating, quarrying, stonework, foundries, sandblasting, ceramics
What are the categories of silicosis
chronic
accelerated
acute
progressive massive
what is hallmark pathology of chronic silicosis
silicotic nodule characterized by whorled hyalinized collagen fibers with more peripheral zone of dust laden macrophages
most common form of silicosis
describe acclereated silicosis
nodules develop after 3-10 yrs exposure
clinical course is progressive
describe acute silicosis
develops 6 mo-2 yrs post exposure
dyspnea, cough, weight loss and rapid progress to respiratory failure and death
alveolar filling process
What characterizes progressive massive fibrosis
lesions at least 1 cm in diameter and larger
lesions involve upper lobe
leads to resp failure, cor pulmonale, weight loss and death
what are associated diseases with silicosis
TB
COPD and chronic bronchitis
collagen vascular disease: RA and scleroderma
lung cancer
CXR silicosis
symmetric nodular pattern with upper lobes
hilar adenopathy with eggshell calcification
acute vs progressive massive silicosis on CXR
acute- air space and interstitial pattern
progressive- coalescence of nodules with larger mass lesions
PFT silicosis
normal ealry in chronic
later it is mixed pattern
Dx silicosis
based on Hx and characteristic X ray changes
management silicosis
irreversible
avoid further damage
TB testing
stop smoking
when do you consider lung transplants in silicosis
acute and accelerated
What causes coal workers pneumoconiosis CWP
deposits of coal dust in lung
increase with intensity of exposure and carbon content
anthracite is most toxic
patholgy CWP
coal macule with macrophages laden with coal dust in walls of respiratory bronchiles and adjacent alveoli
coal nodules
may have progressive massive fibrosis
clinical presentation CWP
no Sx or signs
can have Sx bronchitis
may lead to progressive massive fibrosis
assoc diseases with CWP
silicosis
scleroderma and RA
caplan
Caplan syndrome
RA with large cavitary pulmonary nodules assoc with silicosis and CWP
CXR of CWP
resembles silicosis
small rounded opacities in the lung parenchyma
can progress to progressie massive fibrosis with nodules 0.5 cm- 5 cm
PFT CWP
normal in early
often obstructive can have restrictive if fibrosis present
shown to lead to emphysema
Dx CWP
coal dust exposure
CXR
mangement CWP
avoid exposure
stop smoking
What is asbestosis
chronic fibrotic interstital lung disease secondary to prolonged inhalation of asbestos fibers
20 latency after exposure
industries at risk for asbestosis
mining, milling, transportation asbestos, building demolition, brake lining, ship building, insulations, fireproofing
What is unique pathologically to asbestosis
ferruginous bodies, asbestos bodies
sputum or BAL fluid
Signs and Sx asbestosis
signs: inspiratory crackles, clubbing
Sx: dyspnea, dry cough, chest tightness/pain
Assoc diseases of asbestosis
mesothelioma
lung cancer
pleural effusion
CXR asbestosis
pleural plaques pleural effusion pleural thickening rounded atelectasis with "comet tail" lower lobe and subpleural disease prominent
PFT asbestosis
restrictive
may be obstructive
Dx asbestosis
Hx exposure!!!!! appropriate lag time exposure and disease lung fibrosis on CXR or CT!!!!!! restrictive PFT b/l inspiratory crackles clubbing
management asbestosis
no effective Tx
avoid exposure
stop smoking
lung transplantation
what industries are at higher risk beryllium disease
aerospace, electronics, ceramics, metal, nuclear, telecommunications, tool and die, welding
clinical presentation acute beryllium disease
acute pneumonitis: high exposure
cough, dyspnea, chest pain
blood tinged sputum and crackles
Sx chronic beryllium disease
dyspnea, cough, chest pain, lb loss, fatigue, arthralgias
similar to sarcoidosis ranging from asymptomatic to severe granulomatous restrictive lung disease
20 yrs post exposure
CXR beryllium disease
enlarged hilar or mediastinal nodes or multiple lung nodules or both later: patchy fibrosis, hyperinflation and honeycombing
Dx beryllium disease
documented exposure to beryllium
evidence lung disease
positive BeLPT performed on blood or BAL fluid
management beryllium disease
avoid further exposure
stop smoking
steroids
