Restrictive Lung Diseases/Pneumoconiosis

Question 1

pneumoconiosis

Answer 1

-Restrictive ds
-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.
-CXR: diffuse small opacities especially prominent in the upper lung

Question 3

simple vs complicated coal workers pneumoconiosis

Answer 3

Simple: Usually asymptomatic
- CXR: diffuse small opacities prominent in upper lungs
- Pulmonary function abnormalities are unimpressive/mostly normal
-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

-Jackhammers, cement, construction workers
-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 + specific radiographic finding that strongly suggests silicosis

Question 5

simple vs complicated silicosis

Answer 5

• Simple silicosis: Usually asymptomatic with no effect on routine PFTs
• Complicated silicosis: Large conglomerate densities appear in the upper lung-coalescing of nodules
  -Dyspnea
  -Obstructive and restrictive pulmonary dysfunction -> this is restrictive ds 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
  -even worse if pt is smoker
• Patients with asbestosis usually seek medical attention at least 15 years after exposure
• Sx: Progressive dyspnea. Inspiratory crackles. +/- clubbing and cyanosis.

Question 7

asbestosis: imaging

Answer 7

-Linear streaking at the lung bases
-Opacities of various shapes and sizes
-Honeycomb changes in advanced cases
- Pleural calcifications (50%)
- Plaques.
- Best: High-resolution CT scan (HRCT)
-Detect parenchymal fibrosis + presence of coexisting pleural plaques.

Question 8

asbestosis: cigarette smoking

Answer 8

-Increases prevalence of pleural and parenchymal changes
-increases incidence of lung cancer
-PFTs: Restrictive dysfunction + reduced diffusing capacity