Occupational Lung Disease Jonathan Kass

1. Occupational Lung DiseaseJonathan Kass Cooper University Hospital Robert Wood Johnson School of Medicine UMDNJ at Camden

2. Occupational Lung Disease

3. Occupational Lung Disease

6. Acute HP • Fever • Symptoms:Cough, dyspnea, wheeze • Exam: crackles > wheezes • Leukocytosis • Pulmonary infiltrates

7. Sub-Acute HP • Afebrile/ Normal WBC • Symptoms:Cough, dyspnea, wheeze • Exam: crackles > wheezes • CXR early: near normal • CXR late: Fibrotic changes

8. CXR HP

9. CT Chest HP

10. PFT’s HP • Restrictive > Obstructive • Decreased DLCO • Arterial Oxygen desaturation

11. Pathology HP

12. Diagnosis HP • Clinical symptoms and signs • CXR/CT • PFT • Precipitating Ab’s- not specific • Challenge Testing • Biopsy rarely needed

13. Treatment of HP • Avoidance of allergenic stimulus • Steroids

14. Pneumoconiosis • Asbestos • Silica • Coal • Iron • Talc

15. Amphibole Asbestos

16. Asbestos (Ferruginous) Body

17. Asbestos Related Lung Processes • Pleural Plaques • Benign Asbestos Pleurisy • Asbestosis • Malignant Mesothelioma • Corns

18. Pleural Plaques • Late manifestation > 20 yrs • Usually asymptomatic • When diffuse can have symptoms (restrictive) • Marker of asbestos exposure

19. Benign Asbestos Pleurisy • Earlier manifestation • Often bloody effusion • Mild symptoms to fever, pain and leukocytosis • Treatment: drainage vs observation

20. Asbestosis • Dyspnea • Crackles • Interstitial CXR process • Restriction & decreased DLCO

21. CXR Asbestosis

22. Chest CT Asbestosis

23. Asbestosis Treatment

24. Mesothelioma

25. Malignant Mesothelioma • Asbestos or Zeolite • Late manifestation > 30 yrs • Chest pain • Bloody effusion • Treatment: extensive surgery/chemotherapy

26. Risk of Lung Ca Death per 100,000 man-years Related to Smoking & Asbestos Exposure

27. Quartz Workers

28. Common Silicosis Occupational Exposures • Quarrymen/Miners • Sandblasters/ Stone cutters • Pottery/Glass workers • Foundry workers

29. Silicosis & Disease • Simple • Complicated (progressive massive fibrosis) • Acute silicoproteinosis • Mycobacterial, nocardia, & fungal • Increased connective tissue disease

30. Simple Silicosis • Asymptomatic • Upper lobe nodules < 1cm • “Egg shell” calcified lymph nodes • Normal PFT’s

31. Complicated Silicosis (Progressive Massive Fibrosis) • Late symptoms/normal exam • Coalescence of usually upper lobe nodules to form large shadows • “Egg shell” calcified LN’s, & lobar retraction • Mixed restictive & obstructive PFT’s

32. Acute Silicoproteinosis • Heavy exposure to fine respirable silica (abrasive blasting) • Similar to alveolar proteinosis • Diffuse alveolar CXR pattern • Restictive PFT’s

33. CXR Silicosis

34. Chest CT Silicosis

35. Silicosis Pathology

36. Coal Worker’s Pneumoconiosis • Simple • Complicated • Caplan’s Syndrome

37. CXR Coal Workers Lung

38. Caplan’s Syndrome

39. Cut Section Gross Pathology Coal Workers Lung

40. Coal Workers Lung Pathology

41. Iron (Siderosis) • Radiographic Diagnois: dense small nodules • No symptoms • Normal PFT’s

42. Silicosiderosis • Hematite: iron oxide & silica • Mixed-Dust Fibrosis • Clinically like silcosis

43. Talc • Nodules leading to PMF • Pleural calcifications • Foreign body granulomas

44. Inhalation of Metals • Beryllium • Aluminum • Tungsten Carbide/Cobalt • Tin/Barium • Zinc, Copper, Magnesium

45. Berylliosis • Previously in fluorescent lighting tubes • Nuclear physics, space program, alloys, x-ray tubes • Similar to Sarcoidosis clinically and radiograpically

46. CXR Berylliosis

47. Pathology Berylliosis

48. Aluminum • Pulmonary Fibrosis (Shaver’s Disease) • Asthma

49. Tungsten Carbide/Cobalt • Pulmonary Fibrosis (Hard Metal Disease) • Giant Cell Interstitial Pneumonitis • Asthma

50. Chest CT Stannosis