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Updated: Oct 14 2021


  • 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
    • Epidemiology
      • 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
    • Epidemiology
      • 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
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