Occupational lung diseases, D Kinder, DSA Flashcards
silicosis
fibrotic lung disease caused by inhalation of crystalline silica usually in form of quartz
What industries are at risk for silicosis
mining, tunneling, excavating, quarrying, stonework, foundries, sandblasting, ceramics and stressed denim jean manufacturing
Most common form and presentation of silicosis
chronic silicosis: silicotic nodule characterized by whorled hyalinized collagen fibers with a more peripheral zone of dust laden macrophages
may be asymptomatic or complain of dyspnea. productive cough
What is accelerated silicosis
nodules develop after 3-10 yrs of exposure
clinical course is progressive
what is acute silicosis
6 mo-2 yrs after massive exposure
Sx: dyspnea, cough, wheezing and weight loss that rapidly progresses to respiraotry failure and death
what is progressive massive fibrosis from silicosis
lesions at least 1 cm in diameter, often larger and usually involve the upper lobes
leads to respiratory failure, cor pulmonale, weight loss and death
What are some diseases associated with silicosis
TB
COPD and chronic bronchitis
Collagen vascular disease: RA and scleroderma
Lung cancer
what will a CXR show with silicosis
symmetric nodular pattern involving upper lobes
hilar adenopathy with eggshell calcidication is strongly suggestive
progressive massive fibrosis characterized by coalescence of the nodules with larger mass lesions
acute will show air space and interstitial pattern on x ray
What will silicosis show on PFT
normal early in chronic silicosis, later mixed pattern obstructive and restrictive
Dx of silicosis
based on Hx and characteristic CXR changes
management of silicosis
disease is irreversible
TB testing
stop smoking
consider lung transplants in acute and acclerated silicosis
Coal Workers Pneumoconiosis
deposits of coal dust in lung, increases with intensity of exposure and carbon content
msot toxic component of coal dust
anthracite
pathology of coal pneumoconiosis
coal macule of macrophages laden with coal dust in the walls of respiratory bronchioles and adjacent alveoli
coal nodules
progressive massive fibrosis may be seen
What is clinical presentation of coal workers pneumoconiosis
no Sx or signs
have Sx of bronchitis
may lead to progressive massive fibrosis
What are associated diseases with coal workers pneumoconiosis
silicosis
scleroderma, RA nodules
caplan syndrome
What is caplan syndrome
RA with large cavitary pulmonary nodules associated with silicosis and coal workers pneumoconiosis
What will CXR look like in coal pneumoconiosis
resembles silicosis, small rounded opacities in the lung parenchyma
can prgress to PMF with nodules from 0.5-5cm
what will PFT show in coal pneumoconiosis
normal in early phase
often obstructive in later
someitmes restriction in fibrosis present
shown to lead to emphysema
Dx of coal pneumoconiosis
coal dust exposure, CXR
management of coal pneumoconiosis
avoid exposure and stop smoking
Asbestosis
chronic fibrotic interstitial lung disease secondary to prolonged inhalation of asbestos fibers
20 yr latency between disease and exposure is common
What industries are at risk for asbestosis
mining, milling and transportation of asbestos, building demolition, brake lining, shipbuilding, insulations, fireproofing
What is pathology of asbestosis
ferruginous bodies, asbestos bodies can be found in sputum or BAL fluid
Sx and signs asbestosis
dyspnea, dry cough, chest tightness/pain
inspiratory basal crackles and clubbing
what diseases are associated with asbestosis
mesothelioma
lung cancer
pleural effusion
CXR for asbestosis
pleural plaques, pleural effusion with latency 10-15 yrs
pleural thickening and rounded atelectasis with comet tail, lower lobe and subpleural diseases prominent
PFT for asbestosis
restrictive, may see obstructive
Dx of asbestosis
1 reliable Hx of exposure!!! 2 appropriate lag time between exposure and disease 3 lung fibrosis on CXR!!! 4 restrictive PFT 5 b/l inspiratory crackles 6 clubbing
management of asbestosis
no effective Tx, avoid exposure, stop smoking, lung transplant
What industries are at risk for beryllium disease
aerospace, electronics, ceramic, metal, nuclear, telecommunications, tool and die, welding
What is clniical presentation of acute toxic penumonitis(beryllium disease)
high exposure can lead to HS response that is now rare due to better recognition of beryllium assoc disease
Sx: cough and chest pain
Signs: blood tinged sputum and crackles
Clinical presentation of chronic beryllium disease
similar to sarcoidosis from asymptomatic to severe granulomatous restrictive lung disease
Sx: dyspnea, cough, chest pain, weight loss, fatigue and arthralgias
signs: crackles
osnet 20 yrs after exposure
what will CXR show in beryllium disease
enlarged hilar or mediastinal lymph nodes, multiple lung nodules or both
later stages: patchy fibrosis, hyperinflation and honeycombing
PFT of beryllium disease
restrictive
Dx beryllium disease
documented exposure
evidence lung disease
+ BeLPT performed on blood or BAL fluid
What is BeLPT
beryllium lymphocyte proliferation test
Management of beryllium disease
avoid further exposure, stop smoking, steroids
