Restrictive diseases: substance exposure

Question 1

pneumoconiosis

Answer 1

-restrictive
-Fibrotic lung diseases caused by the inhalation of coal dust and various other inert, inorganic, or silicate dusts
-what do you do for work…what DID you do for work
-Clinically important pneumoconioses include:
-Coal workers’ pneumoconiosis
-Silicosis
-Asbestosis
-Treatment for each is supportive

Question 2

coal workers pneumoconiosis

Answer 2

-Ingestion of inhaled coal dust by alveolar macrophages
-Formation of coal macules, usually 2–5 mm diameter
-Appears on cxr as diffuse small opacities especially prominent in the upper lung

Question 3

simple vs complicated coal workers pneumoconiosis

Answer 3

-Simple coal worker’s pneumoconiosis:
-Usually asymptomatic
-CXR: diffuse small opacities prominent in upper lungs
-Pulmonary function abnormalities are unimpressive

-Complicated coal worker’s pneumoconiosis (“progressive massive fibrosis”)
-Conglomeration and contraction in the upper lung zones
-very fibrotic lung
-Radiographic features resembling complicated silicosis

Question 4

silicosis

Answer 4

-Extensive or prolonged inhalation of free silica (silicon dioxide) particles in the respirable range (0.3–5 mcm)
-Formation of small rounded opacities (silicotic nodules) throughout the lung
-Calcification of the periphery of hilar lymph nodes (“eggshell” calcification)*
-Unusual radiographic finding that strongly suggests silicosis

Question 5

simple vs complicated silicosis

Answer 5

-Simple silicosis:
-Usually asymptomatic
-No effect on routine pulmonary function tests

-Complicated silicosis:
-Large conglomerate densities appear in the upper lung-coalescing of nodules
-Dyspnea
-Obstructive and restrictive pulmonary dysfunction -> this is restrictive tho

Question 6

asbestosis

Answer 6

-Workers exposed to asbestos fibers
-Shipyard and construction workers, pipe fitters, insulators
-Exposure over many years (approx 10–20yrs)
-Causes a nodular interstitial fibrosis
-many additive affects if pt is smoker

-Patients with asbestosis usually seek medical attention at least 15 years after exposure
-Progressive dyspnea
-Inspiratory crackles
-+/- clubbing and cyanosis

Question 7

asbestosis: imaging

Answer 7

-Radiographic features of asbestosis:
-Linear streaking at the lung bases
-Opacities of various shapes and sizes
-Honeycomb changes in advanced cases
-Pleural calcifications (50%)*
-plaques

-High-resolution CT scanning is the best imaging method for asbestosis
-Detect parenchymal fibrosis
-Presence of coexisting pleural plaques

Question 8

asbestosis: cigarette smoking

Answer 8

-Increases prevalence of pleural and parenchymal changes
-Markedly increases incidence of lung carcinoma

-PFTs:
-Restrictive dysfunction
-Reduced diffusing capacity