Pneumoconiosis

Background

Extensive fibrosis of pleura and lung parenchyma from asbestos exposure.

• 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

An example of clubbing.

• 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

Bilateral fibrothorax caused by asbestos exposure.

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

See Also

• Idiopathic pulmonary fibrosis

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.