Pneumoconiosis, asbestosis, lung abscess, empyema Flashcards
Pathology of Coal worker’s pneumoconiosis (CWP)
Inhalation + deposition of coal dust particles
Induces formation of peribronchovascular coal macules - pigment + reticulin fibres present
What does coal dust contain?
Silica + silicates
Radiological findings of Coal worker’s pneumoconiosis (CWP)
Small, rounded, nodular opacities, usually in upper lobe
Confluence of these leads to progressive massive fibrosis
Investigations for Coal worker’s pneumoconiosis (CWP)
CXR
FDG-PET
What is Caplan syndrome?
Complication of Coal worker’s pneumoconiosis
Occurs with joint manifestations of RA
Peripheral lung rheumatoid nodules develop on background of pneumoconiotic opacities
Pathology of asbestosis
Pneumoconiosis due to inhalation of asbestos fibres
S+S of asbestosis
Asymptomatic for 20-30 years
Insidious onset SOB with exertion
End-inspiratory crackles, reduced lung volume
CT findings for asbestosis
Subpleural linear densities of varying length parallel to the pleura
Basilar and dorsal lung parenchymal fibrosis, with peribronchiolar, intralobular, and interlobular septal fibrosis
Coarse parenchymal bands (2 to 5 cm in length), often contiguous with the pleura
Coarse honeycombing in advanced disease
Pleural plaques
What are benign asbestos pleural effusions?
Small + unilateral, occur years before onset of interstitial disease
Complications of asbestosis
Mesothelioma
Pleural plaques
Pleural thickening
Pathology of lung abscess
Necrosis of pulmonary parenchyma caused by microbial infection
Causes of lung abscesses
Usually due to aspiration pneumonia
Caused by anaerobes - peptostrep, prevotella, bacteroides, fusobacterium
S+S of lung abscess
Insidious onset of fever, cough, sputum production
Night sweats, weight loss + anemia
Haemopytsis or pleurisy
Diagnosis of lung abscess
CXR revealing pulmonary infiltrate with cavity
Air fluid level present
Management of lung abscess
Penicillin or carbopenem
What is empyema?
Effusion that forms in pleural space adjacent to pneumonia
Cause of empyema
Pneumonia
What are the stages of empyema?
Stage 1 - fluid is free-flowing + small
Stage 2 - fibrinopurulent stage where infection precipitates
Stage 3 - thickened fibrinous coating that may limit lung expansion
RF for empyema
Aspiration Poor dental hygiene Alcohol or IVDU Immunosuppression Extremes of age Reflux
Investigations for empyema
CXR
US + sample taken
CT
What are the differentials for empyema?
Pleural fluid acidosis (malignancy, TB, lupus, pleurisy)
Pleural masses
Lung abscess
Management of empyema
Abx
Drainage if large
Thrombolytics/ fibrinolytics through chest drain to break down pus (streptokinase/ tPa)
What lung disease can asbestos cause?
Pleural effusion + plaques Diffuse pleural thickening Asbestosis = UIP pattern of fibrosis due to asbestos Lung cancer Mesothelioma
When can someone make a claim for asbestos disease?
Within 2 years of diagnosis