Pneumoconiosis and Sarcoidosis Flashcards
Define sarcoidosis
Multisystem disease characterized by noncaseating granulomas
Etiology of sarcoidosis
Unknown
Epidem: when does sarcoidosis peak?
Young adults
Ages > 60 years
What is the pathophy of sarcoidosis?
T lymphocytes initiate alveolitis –> leads too macrophage, mast cell, monocytes, and fibroblast recruitment –> leads to non-caseating granulomas
Sarcoidosis restrictive or obstructive?
Restrictive
What are the signs/symptoms of sarcodosis?
Non productive cough, dyspnea, rhonchi, wheezing, lymphadenopathy
Cutaneous: erythema, maculopapular rash
Ocular signs: blindness, chronic dry eyes
What is needed to dx sarcoidosis?
Clinical presentation + biopsy
What are some CXR results of sarcoidosis?
Hilar, paratracheal lymphadenopathy
Upper lobe, mainly, bilateral, infiltrates
What is the main treatment of sarcoidosis?
Watch it!
Then can use glucocorticoids
- -> topical for single organ
- -> oral for multiorgan
What if a patient is intolerant to steroids? How would you then treat a patient with sarcoidosis?
Hydroxycholroquine for skin (contraindicated in the eye)
Methotrexate
Define pneumoconioses asbestosis
Diffused pulmonary interstitial fibrosis occurring in asbestos exposed workers/bystanders/community
Etiology of pneumoconioses asbestosis
Asbestos fibers
–> amphibole type is more toxic than chrysotile
What do asbestos fibers cause?
trigger alveolitis –> inflammation –> scarring and fibrosis –> dec. pulmonary function
Presentation of pneumoconioses asbestosis
Chest pain
Productive cough
DOE
Rales
Clubbing
What diagonistic tests to run and what do they show?
CXR - pleural plaques, calcification in lower lung fields, pleural effusions
PFTs - Dec FVC and FEV1/FVC ratio, dec TLC, dec. DLCO
HRCT - Lower zone fibrosis, pleural thickening
Lung Biopsy - parenchymal asbestos bodies
Treatment for pneumoconioces asbestosis
NO EFFECTIVE TX Stop smoking Bronchodilator if there is co-existing COPD Pulm rehab O2 therapy Lung transplant
Complications of asbestos?
- Cor pulmonale
- Malignancy (Lung cancer mc…then mesothelioma)
- Pulmonary HTN
- Right sided heart failure
Coal Worker’s Pneumoconiosis (CWP): what is the histologic hallmark?
Coal macules
–Areas of focal deposition of coal dust and pigment-laden macrophages
What are complications of coal worker’s pneumoconiosis
- Progressive massive fibrosis
- Caplan syndrome
- -> Rhematoid arthritis w/ pneumoconiotic nodules - T.B
- Cancer
- -> Squamous cell
When do miners get CXR’s?
Get one as soon as they are hired and then every 5 years
What is the most common form of crystalline silica?
Quartz
What diagnostic test is needed to dx pneumoconioses silicosis?
CXR
–> can get CT if it is progressive massive fibrosis
What do PFT results look like in pneumoconioses silicosis
Mixed pattern of obstructive and restrictive
What test is indicated in all persons w/ silicosis?
PPD
Treatment of pneumoconioses silicosis
- Prevent further exposure
- Quit smoking
- Immunize
- Corticosteroids benefit in acute silicosis
- Consult Pulmonologist
Pathophysiology of pneumoconioses: chronic beryllium disease
T-cell proliferation –> proinflammatory cytokines –> non-caseating granulomatous inflammation
What are the 2 things needed to Dx CBD?
- Evidence of sensitization to beryllium
2. Presence of compatible lung pathology
Treatment for Chronic Beryllium Disease
- Refer to pulmonologist
- Symptomatic tx
- Corticosteroids
- Methotrexate considered if corticosteroids fail
