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Occupational Lung Disease Jonathan Kass

Occupational Lung Disease Jonathan Kass. Cooper University Hospital Robert Wood Johnson School of Medicine UMDNJ at Camden. Occupational Lung Disease. Occupational Lung Disease. Acute HP. Fever Symptoms:Cough, dyspnea, wheeze Exam: crackles > wheezes Leukocytosis Pulmonary infiltrates.

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Occupational Lung Disease Jonathan Kass

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  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

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

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

  6. CXR HP

  7. CT Chest HP

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

  9. Pathology HP

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

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

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

  13. Amphibole Asbestos

  14. Asbestos (Ferruginous) Body

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

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

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

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

  19. CXR Asbestosis

  20. Chest CT Asbestosis

  21. Asbestosis Treatment

  22. Mesothelioma

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

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

  25. Quartz Workers

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

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

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

  29. 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

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

  31. CXR Silicosis

  32. Chest CT Silicosis

  33. Silicosis Pathology

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

  35. CXR Coal Workers Lung

  36. Caplan’s Syndrome

  37. Cut Section Gross Pathology Coal Workers Lung

  38. Coal Workers Lung Pathology

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

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

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

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

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

  44. CXR Berylliosis

  45. Pathology Berylliosis

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

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

  48. Chest CT Stannosis

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