Pneumoconioses

Question 0

Silicosis

Answer 0

• Small rounded opaque and progress to confluent opacities, to progressive massive fibrosis
• Upper lung small rounded nodules
• Increased risk of TB infection
• Restrictive lung disease
• Silica is carcinogenic

Question 1

Pneumoconiosis

- restrictive lung diseases/ chronic fibrotic occupational lung disease

Answer 1

Dust lung
10-20 years exposure 
Permanent parenchymal fibrotic change
Restrictive lung diseases
Eg. Silicosis 
      Asbestosis
      Coal worker's pneumoconiosis 
      Beryllium 
      Hard metals (cobalt-tungsten carbide)

Question 2

Coal workers’ pneumoconiosis

Answer 2

• Macule loaded with coal dust

- Less fibrogenic than silica

Question 3

Asbestos diseases

Answer 3

1. Asbestosis (remember! This refers to the pneumoconiosis)
2. Benign pleural effusion (1st manifestation of asbestos exposure after about 10 years of exposure)
3. Pleural plaques
4. Lung cancer
5. Mesothelioma

Question 4

Asbestos

Answer 4

• Serpentine (curly fibers) (chrysotile) - most in use ( 95%)
• Amphibole ( needle like) - more carcinogenic

Latency - at least 20 years

Question 5

Asbestosis chest x- ray

Answer 5

Small irregular or linear opacities, fibrosis, esp. at the base of the lung

(Compare to silicosis - small rounded opacities mainly in upper lobes)

Question 6

Asbestos pathology

Answer 6

Asbestos body
= protein coated fiber which contains iron (ferruginous body)

• only pathological feature unique to asbestosis

Question 7

Bilateral Upper lung small rounded nodules in x-ray

Answer 7

Silicosis

Question 8

Bilateral linear fibrotic changes in the lower lobe

Answer 8

Asbestosis

Question 9

Asbestos + tobacco

Answer 9

1. Increases susceptibility for asbestosis
2. Increases risk for bronchogenic cancer
3. Increased risk for cancer of esophagus, oropharynx and larynx among smokers

(Not for mesothelioma)

Question 10

Synergistic risk of asbestos and smoking for lung cancer

Answer 10

Non-smoker, non-asbestos exposure: RR = 1 (ref)
Asbestos workers: RR = 5.2
Smokers: RR = 10.8
Smokers+asbestos: RR = 53.2

Question 11

Egg shell calcification on x-Ray

Answer 11

Silicosis
- silica can be transported by macrophages via pulmonary lymphatics to the hilar nodes, that appear as “egg shell calcifications” on x- ray

Question 12

Fibrosis and small rounded opacities without hilar node calcification on x-ray?

Answer 12

Coal worker’s pneumoconiosis

Question 13

Non-caseating granulomatous lesions in the lungs

Answer 13

Beryllium disease

Sarcoidosis

Question 14

Beryllium lung disease CXR

Answer 14

Upper to middle love interstitial infiltrates, hilar adenopathy

Question 15

Which of the dusts causes pulmonary fibrosis, rather than simple pneumoconiosis?

Answer 15

Bagasse