Pneumoconiosis, asbestosis, lung abscess, empyema

Question 1

Pathology of Coal worker’s pneumoconiosis (CWP)

Answer 1

Inhalation + deposition of coal dust particles

Induces formation of peribronchovascular coal macules - pigment + reticulin fibres present

Question 2

What does coal dust contain?

Answer 2

Silica + silicates

Question 3

Radiological findings of Coal worker’s pneumoconiosis (CWP)

Answer 3

Small, rounded, nodular opacities, usually in upper lobe

Confluence of these leads to progressive massive fibrosis

Question 4

Investigations for Coal worker’s pneumoconiosis (CWP)

Answer 4

CXR

FDG-PET

Question 5

What is Caplan syndrome?

Answer 5

Complication of Coal worker’s pneumoconiosis
Occurs with joint manifestations of RA
Peripheral lung rheumatoid nodules develop on background of pneumoconiotic opacities

Question 6

Pathology of asbestosis

Answer 6

Pneumoconiosis due to inhalation of asbestos fibres

Question 7

S+S of asbestosis

Answer 7

Asymptomatic for 20-30 years
Insidious onset SOB with exertion
End-inspiratory crackles, reduced lung volume

Question 8

CT findings for asbestosis

Answer 8

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

Question 9

What are benign asbestos pleural effusions?

Answer 9

Small + unilateral, occur years before onset of interstitial disease

Question 10

Complications of asbestosis

Answer 10

Mesothelioma
Pleural plaques
Pleural thickening

Question 11

Pathology of lung abscess

Answer 11

Necrosis of pulmonary parenchyma caused by microbial infection

Question 12

Causes of lung abscesses

Answer 12

Usually due to aspiration pneumonia

Caused by anaerobes - peptostrep, prevotella, bacteroides, fusobacterium

Question 13

S+S of lung abscess

Answer 13

Insidious onset of fever, cough, sputum production
Night sweats, weight loss + anemia
Haemopytsis or pleurisy

Question 14

Diagnosis of lung abscess

Answer 14

CXR revealing pulmonary infiltrate with cavity

Air fluid level present

Question 15

Management of lung abscess

Answer 15

Penicillin or carbopenem

Question 16

What is empyema?

Answer 16

Effusion that forms in pleural space adjacent to pneumonia

Question 17

Cause of empyema

Answer 17

Pneumonia

Question 18

What are the stages of empyema?

Answer 18

Stage 1 - fluid is free-flowing + small
Stage 2 - fibrinopurulent stage where infection precipitates
Stage 3 - thickened fibrinous coating that may limit lung expansion

Question 19

RF for empyema

Answer 19

Aspiration 
Poor dental hygiene 
Alcohol or IVDU 
Immunosuppression 
Extremes of age 
Reflux

Question 20

Investigations for empyema

Answer 20

CXR
US + sample taken
CT

Question 21

What are the differentials for empyema?

Answer 21

Pleural fluid acidosis (malignancy, TB, lupus, pleurisy)
Pleural masses
Lung abscess

Question 22

Management of empyema

Answer 22

Abx
Drainage if large
Thrombolytics/ fibrinolytics through chest drain to break down pus (streptokinase/ tPa)

Question 23

What lung disease can asbestos cause?

Answer 23

Pleural effusion + plaques 
Diffuse pleural thickening 
Asbestosis = UIP pattern of fibrosis due to asbestos 
Lung cancer 
Mesothelioma

Question 24

When can someone make a claim for asbestos disease?

Answer 24

Within 2 years of diagnosis

Question 25

What jobs can have asbestos exposure?

Answer 25

Carpenters
Plumbers 
Electricians 
Laggers 
Painters 
Builders 
Ship builders
Factory workers

Question 26

What are pleural plaques?

Answer 26

Over areas of friction (ribs)

Holly leaf appearance