Updated: 12/5/2020

Pneumoconioses

0%
Topic
Review Topic
0
0
N/A
N/A
Questions
8 8
0
0
0%
0%
Evidence
8 8
0
0
0%
0%
Videos
1 1
Overview
  • Definition
    • inhalation of small dust particles (coni = latin for dust)
  • Pathophysiology
    • varied and based on the type of dust
    • fibrogenicity
      • coal (least), asbestos, silica, and beryllium (most)
    • region of respiratory tract involved (and mechanism of clearance) depends on particle size
      • small particles affect alveoli (< 2 microns)
        • phagocytosed by macrophages
      • intermediate particles affect respiratory bronchioles ( > 2 microns but < 10 microns)
        • cleared by mucociliary transport
      • large particles are trapped in the upper respiratory tract
    • all result in interstitial fibrosis
      • ↑ incidence of cor pulmonale due to pulmonary hypertension
Coal workers pneumoconiosis (CWP)
  • Epidemiology
    • workers of coal mines and inhabitants of large cities
  • Pathology
    • affects upper lobes (high ventilation)
    • macrophages phagocytose particles ("dust cells")
  • Sequelae 
    • no association with lung cancer
    • simple CWP
      • like smoking, can produce centrilobular emphysema
      • 1 cm fibrotic centers
    • complicated CWP
      • 1-2 cm fibrotic centers
    • Caplan's syndrome
      • CWP + rheumatoid nodules in lungs
Asbestosis
  • asbestosbodEpidemiology
    • workers in shipbuilding, roofing, and plumbing industries
      • asbestos used for insulation
  • Pathology
    • affects lower lobes including the entire respiratory unit
    • presence of asbestos bodies (aka ferruginous bodies) 
      • golden-brown fusiform rods (due to iron and protein deposition)
        • resemble dumbbells → made of iron!
      • located inside macrophages
  • Sequelae
    • calcified pleural plaques in the diaphragm and posterolateral mid lung 
    • ↑ incidence of bronchogenic carcinoma and mesothelioma 
      • bronchogenic carcinoma more common than mesothelioma
      • mesothelioma takes longer time to develop (25-40 years) so is less common
      • smoking has no effect on mesothelium, but amplifies the risk of bronchogenic carcinoma when combined with asbestos
    • no association with TB
    • may also result in Caplan's syndrome
Silicosis
  • silicosisEpidemiology
    • workers in foundries, sandblasting, and mining industries
  • Pathology
    • affects upper lobes
    • macrophages activated by silica (quartz)
      • release fibrogenic cytokines
    • biopsy shows silica particles (birefringent) surrounded by collagen 
    • "eggshell" calcification of hilar lymph nodes  
  • Sequelae
    • may impair macrophage function
      • ↑ susceptibility to TB
    • ↑ incidence of primary lung cancer
Berylliosis
  • Epidemiology 
    • aerospace or nuclear industry workers
  • Pathology
    • noncaseating granulomas, nodular infiltrates, and enlarged lymph nodes
      • resembles sarcoidosis
  • Sequelae
    • ↑ risk for primary lung cancer 
 

Please rate topic.

Average 4.7 of 6 Ratings

Questions (8)
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK

(M1.PL.17.4709) A 76-year-old man with chronic obstructive pulmonary disease (COPD) presents complaining of 3 weeks of cough and progressive dyspnea on exertion in the setting of a 20 pound weight loss. He is a 60 pack-year smoker, worked as a shipbuilder 30 years ago, and recently traveled to Ohio to visit family. Chest radiograph shows increased bronchovascular markings, reticular parenchymal opacities, and multiple pleural plaques. Labs are unremarkable except for a slight anemia. Which of the following is the most likely finding on this patient's chest CT? Tested Concept

QID: 108478
1

Nodular mass spreading along pleural surfaces

55%

(127/232)

2

Honeycombing

13%

(31/232)

3

Air bronchogram

3%

(7/232)

4

Granulomatous nodule

10%

(24/232)

5

Lower lobe cavitary mass

16%

(38/232)

M 2 C

Select Answer to see Preferred Response

(M1.PL.15.118) A 42-year-old male presents to your office complaining of dyspnea on exertion. During the interview, the patient notes that he is a contractor specializing in the construction of aviaries at zoos. A radiograph of his chest is shown in Figure A . What is the diagnosis? Tested Concept

QID: 100921
FIGURES:
1

Asbestosis

12%

(5/40)

2

Progressive massive fibrosis

0%

(0/40)

3

Silicosis

30%

(12/40)

4

Berylliosis

0%

(0/40)

5

Bird fancier's lung

58%

(23/40)

M 2 D

Select Answer to see Preferred Response

Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK

(M1.PL.13.21) A 72-year-old retired shipyard worker received a chest x-ray as part of a routine medical work-up. The radiologist reported incidental findings suggestive of an occupational lung disease. Which of the following descriptions is most consistent with this patient's film? Tested Concept

QID: 100824
1

Enlarged hilar lymph nodes

10%

(4/39)

2

Fibrocalcific parietal pleural plaques on the diaphragm

85%

(33/39)

3

Hyperinflated lungs with a loss of lung markings

0%

(0/39)

4

Nodular calcium lesions in the apex of the lung

5%

(2/39)

5

No specific radiographic findings

0%

(0/39)

M 2 E

Select Answer to see Preferred Response

(M1.PL.13.101) A 45-year-old male reports several years of asbestos exposure while working in the construction industry. He reports smoking 2 packs of cigarettes per day for over 20 years. Smoking and asbestos exposure increase the incidence of which of the following diseases? Tested Concept

QID: 100904
1

Chronic bronchitis

2%

(2/103)

2

Emphysema

9%

(9/103)

3

Multiple myeloma

1%

(1/103)

4

Malignant pulmonary mesothelioma

30%

(31/103)

5

Bronchogenic carcinoma

57%

(59/103)

M 1 E

Select Answer to see Preferred Response

Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Evidence (10)
VIDEOS (1)
Topic COMMENTS (8)
Private Note