Pneumoconiosis

Question 1

What is Pneumoconiosis?

Answer 1

Fibrosing interstitial lung disease caused by chronic inhalation of mineral dusts

Question 2

List 4 types of Pneumoconiosis

Answer 2

Simple (symptom-free)
Complicated: results in loss of lung function
Asbestosis
Caplan’s syndrome

Question 3

Describe the aetiology of Pneumoconiosis

Answer 3

Caused by inhalation of particles of:  
Coal dust   
Silica   
Asbestos
Beryllium

Question 4

What does Pneumoconiosis often co-exist with?

Answer 4

Chronic bronchitis

Question 5

List 4 risk factors for development of and severity of Pneumoconiosis

Answer 5

Occupational exposure (coal mining, quarrying, iron + steel foundries, plumbers, ship builders)
Extent of exposure + the size/shape of particles
Individual susceptibility
Smoking + TB

Question 6

Describe the epidemiology of Pneumoconiosis

Answer 6

Incidence increasing in developing countries

Disability + mortality from asbestosis will continue to increase for the next 20-30 yrs

Question 7

Give a sign of Coal worker’s Pneumoconiosis and Sillicosis

Answer 7

Decreased breath sounds

Question 8

Give 2 signs of Asbestosis

Answer 8

End-inspiratory crackles

Clubbing

Question 9

What signs may Pneumoconiosis present with?

Answer 9

Signs of pleural effusion or RHF (cor pulmonale)

Question 10

How may Pneumoconiosis present?

Answer 10

Examination may be NORMAL (esp. early stages)

Asymptomatic: picked up on routine CXR

Question 11

List 4 symptoms of Pneumoconiosis

Answer 11

Insidious onset SOB (SOBOE)
Dry cough
Black sputum (melanoptysis): coalworker’s
Pleuritic chest pain (due to acute asbestos pleurisy in asbestosis)

Question 12

Describe CXR finings in simple Pneumoconiosis

Answer 12

micronodular mottling

Question 13

Describe CXR findings in complicated Pneumoconiosis

Answer 13

Nodular opacities in upper lobes

Micronodular shadowing

Question 14

What may be seen on spirometry in Pneumoconiosis?

Answer 14

Obstructive or restrictive pattern but useful to determine severity + pharmacological tx

Question 15

What investigations may be performed in Pneumoconiosis?

Answer 15

CXR (PA + Lateral)
Spirometry
Beryllium lymphocyte proliferation test (BeLPT)
CT Scan: fibrotic changes visualised
Bronchoscopy: visualisation + bronchoalveolar lavage

Question 16

What should patients with silicosis be tested for?

Answer 16

TB

Skin or blood test

Question 17

What characteristic CXR sign is seen in Silicosis?

Answer 17

Eggshell calcification of hilar lymph nodes

Question 18

What characteristic CXR sign is seen in Asbestosis?

Answer 18

Bilateral lower zone reticulonodular shadowing + pleural plaques

Question 19

What causes simple pneumoconiosis? What is this AKA?

Answer 19

Due to inhalation of coal dust particles over 15-20 yrs.
Particles ingested by macrophages which die, releasing their enzymes + causing fibrosis.
Coalworker’s pneumoconiosis or silicosis

Question 20

What is asbestosis?

Answer 20

a pneumoconiosis in which diffuse parenchymal lung fibrosis occurs as a result of prolonged exposure to asbestos

Question 21

What is Caplan’s syndrome?

Answer 21

Rare subset of pneumoconiosis characterized by development of pulmonary nodules in combination with rheumatoid arthritis.

Question 22

What does the Beryllium lymphocyte proliferation test (BeLPT) identify? What disease does this clinically and radiologically mimic?

Answer 22

Berylliosis: If sensitised to beryllium then positive response 
Mimics sarcoidosis (non caseating granulomas)