Environmental Lung Disease (Pneumoconiosis) AGAINDRA K. BEWTRA M.D.

Transcription

1 Environmental Lung Disease (Pneumoconiosis) AGAINDRA K. BEWTRA M.D.

2 Pneumoconiosis Originally pneumoconiosis (gr: Pneumo = lung; konis = dust). So it was those diseases caused by dust inhalation, but in recent days it includes diseases caused by toxic fumes, gases and organic materials. Pneumoconiosis is quite often due exposure to dusts at work and so are called Occupational Lung Diseases. A number of these cases are medico-legal cases. Correct diagnosis very often requires a good knowledge of clinical symptoms, pulmonary function tests, pathological findings, and radiological findings.

3 Pneumoconiosis

4 Pneumoconiosis

5 Iron and other Inert dusts Aluminum (Bauxite workers); Antimony (miners); Barium causes Baritosis (miners); Chromium (miners); Iron causes Siderosis (Iron workers); Rare earths (optical glass); Tin causes Stannosis (mining); Titanium (mining and paint). They cause mild local fibrosis and some functional loss. Pathology: pigmented lungs; coal - black; hematite (iron) - red; tin - gray; titanium -white X-Rays: spectacular Usually asymptomatic but can cause loss of lung function. Inert particles may be carcinogenetics.

6 Coal Worker s Pneumoconiosis Depends on type of mine (open pit vs underground), type of coal, mining conditions, and amount of dust exposure. 5% of workers get disease CWP can be divided into simple and complicated. Simple CWP consists of finely nodular infiltrates Complicated CWP causes progressive massive fibrosis. Pathologic findings could be: Macules; Nodules; Massive fibrosis; Caplan s lesions; and Interstitial fibrosis.

7 CWP Smoking very significantly increases CWP and fibrosis. Incidence of TB is greatly increased. Caplan s lesions, or rheumatoid pneumoconiosis occurs in patients with rheumatoid arthritis but can occur without actual disease. Diffuse interstitial fibrosis occurs in about 18% of cases.

8 CWP

9 CWP

10 CWP

11 CWP

12 CWP

13 CWP

14 Silicosis Silicosis is disease caused by crystalline silica (SiO2) and not by silicates Silica is very fibrogenic.. Silica can be in several mineral form: quartz, cristobalite, and tridymite are most common. Miners, Quarry workers, stone engravers and polishers, stonecutters, ceramic manufacturers, use and manufacture of silica-containing abrasives and fillers, foundry workers, sand-blasters and grinders.

15 Silicosis Pathology: macules, silicotic nodules, progressive massive fibrosis, silicoproteinosis, mixed dust fibrosis, and diffuse interstitial fibrosis. Increased incidence of TB? Increased incidence of malignancies, not likely.

16 Silicosis

17 Silicosis

18 Silicosis

19 Silicosis

20 Silicosis

21 Silicosis

22 Silicosis

23 Asbestosis Asbestos is a generic term for a variety of naturally fibrous silicate minerals. (High tensile strength, high heat resistance, and impervious to chemical attack. Construction materials, cement, packing, gaskets, insulating products and in some textiles. Asbestos can be chrysotile or white asbestos (90%) or the amphibole groups (amosite, crocodolite). In the lung asbestos can be present as a bare asbestos fiber or as ferruginous bodies, where the body has covered the fibers with iron-protein.

24 Asbestosis Asbestos-Induced Diseases: Benign pleural lesions: Pleural effusion, pleural fibrosis, pleural plaques, pleural pseudotumors Benign parenchymal lesions: Fibrosis of small airways, asbestosis Neoplasms: Malignant mesotheliomas, carcinoma of lung,? Other cancers

25 Asbestosis No known effective defence against asbestos Asbestos fibers can be present for decades before causing any disease. Crocidolite extremely carcinogenetic, whereas chrysotile is a very weak carcinogen. Inter-relationship of asbestosis with smoking is not fully understood at the present time. Most likely smoking in patients with asbestosis increases the risk of various malignancies.

26 Asbestosis

27 Asbestosis

28 Asbestosis

29 Asbestosis

30 Asbestosis

31 Asbestosis

32 Asbestosis

33 Asbestosis

34 Asbestosis

35 Asbestosis

36 Asbestosis-Mesothelioma

37 Silicate Pneumoconiosis Silicate minerals consist of silicon dioxide combined with one or more cation such as Al, Ca, Mg etc. Some of the important silicates are kaolin, talc, mica, and fuller s earth etc. Silicates may be contaminated with more toxic materials like asbestos and makes the product toxic. Ferruginous bodies may be formed by silicates. Disease produced by silicates very similar to diseases caused by silica.

38 Silicate Pneumoconiosis Kaolin: manufacture of rubber, ceramics, plastics, paper, pharmaceuticals, paints, mining and processing. Talc: Manufacture of ceramics, paints, paper refactories, building materials, rubber, plastics, insecticides, cosmetics and pharmaceuticals, mining & processing Mica: Electric and thermal insulation products, building products, asphalts, paints, cements, rubber & plastic production. Mining and processing. Fuller s earth: Oil refining & drilling,as a filtering agent, paint fillers, cosmetics, pharmaceuticals. Mining/processing

39 Intravenous Talcosis Causes Talc granulomatosis. Common fillers of oral medications are of three kinds: talc, microcrystalline cellulose, and cornstarch. IV drug users inject these oral drugs and thereby inject these fillers. These agents cause: Intravenous/perivascular foreign body granulomas, angiothrombosis, diffuse interstitial fibrosis, and massive fibrosis- like lesions

40 Intravenous Talcosis Talc: Ritalin, Pyribenzamine, Methadone, Darvon, Demerol, Benzedrine, Dilaudid. Microcystalline cellulose: Talwin, Quaalude, Percodan, Acetaminphen/aspirin with codeine, Phenobarbital Cornstarch: Barbiturates, paragoric, pyribenzamine, Talwin.

41 Berylliosis Rare metal that is light weight, and has high tensile strength, high melting point, excellent alloying properties, and ability to reduce the speed of nuclear fission Found in alloys, ceramics, and X-Rays and vacuum tubes.

42 Berylliosis - Acute Toxic dose-dependant lung injury characterized by acute irritation of the upper airways, bronchiolitis, pulmonary edema, and chemical pneumonitis Clinically present with dysnea, cough, chest pain, blood-tinged sputum, rales and cyanosis

43 Berylliosis - Chronic Multisystem disorder with granulomas throughout the body. May or may not be preceded by acute form Clinically present with dysnea, progressive and unremitting cough, chest pain, weight loss, fatigue, and arthralgias

44 Berylliosis

45 Berylliosis

46 Berylliosis

47 Berylliosis

48 Berylliosis

49 Berylliosis

50 Pneumoconiosis - Prevention

51 Pneumoconiosis - Prevention

52 Pneumoconiosis - Prevention