Pneumoconiosis
Background
- A chronic inflammatory lung disease caused by inhalation of particles, typically occupationally related, that typically results in pulmonary fibrosis and eventually restrictive lung disease.
Types based on inhaled particle
- Asbestosis: shipping, roofing, plumbing, demolition
- Berylliosis: aerospace, fluorescent bulbs
- Byssinosis: cotton
- Silicosis: foundries, sandblasting, mines
- Coal worker's lung: coal
- Siderosis: iron
- Stannosis: tin
Clinical Features
- May be asymptomatic, with normal PFTs, especially initially
- Dyspnea
- Crackles on exam
- Features of restrictive and/or obstructive pulmonary dysfunction
- If severe, clubbing, cyanosis
Differential Diagnosis
Pulmonary Fibrosis
- Interstitial pneumonias (acute, lymphocytic)
- Lung malignancy
- Aspiration pneumonia or pneumonitis
- Bacterial, viral, or fungal pneumonia
- Cryptogenic organizing pneumonia
- Interstitial lung disease associated with collagen vascular disease
- Drug-induced pulmonary toxicity (amiodarone, bleomycin, amphotericin B, carbamazepine, etc.)
- Eosinophilic granuloma (Histiocytosis X)
- Radiation pneumonitis
- Sarcoidosis
- Pneumoconiosis (Workplace exposure)
- Asbestosis
- Berylliosis
- Chemical worker's lung
- Coal worker's pneumoconiosis
- Silicosis
Evaluation
Evaluate for and treat for reversible causes of symptoms or exacerbation of symptoms
- CXR:
- Coal workers': diffuse nodular opacities, especially prominent in upper lung
- Silicosis: Large conglomerate densities in upper lung
- Asbestosis: linear streaking at bases, opacities, honeycomb changes if advanced
- CT Chest
- Best imaging for asbestosis, can detect parenchymal fibrosis and characterize pleural plaques
- TB testing
- Increased incidence of TB in patients with silicosis
Management
- Treatment is supportive
Disposition
See Also
References
- Meyer KC. Beryllium and lung disease. Chest. Sep 1994;106(3):942-6.
- Kreiss K, Miller F, Newman LS, Ojo-Amaize EA, Rossman MD, Saltini C. Chronic beryllium disease--from the workplace to cellular immunology, molecular immunogenetics, and back. Clin Immunol Immunopathol. May 1994;71(2):123-9.