DRSHHASHEMI TERMINOLOGY COAL is used as a basic fuel for numerous industries requiring a source of heat Coal dust containe Silica Kaolin PAH Quarts Carbon Pneumoconiosis ID: 361577
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Coal Worker’s Pneumoconiosis ( CWP )
DR.S.H.HASHEMISlide3
TERMINOLOGY
COAL
is used as a basic fuel for numerous industries requiring a source of heat.
Coal dust
containe
Silica
,
Kaolin
,
PAH
,
Quarts
,
Carbon
.
Pneumoconiosis :
the radiologic or pathologic appearances relating to the accumulation of lung dust deposits and the associated tissue reactions.Slide4
Clinical effects of coal dust :
Acute effects:
acute drop in
FEV1
( months to years ).
Chronic effects:
CWP
(≥ 10-20 y )
Term
CWP
: a chronic,
irriversible
disease with insidious onset
A heavy coal dust burden is required to induce CWP
Rarely in those who have spent fewer than 10-20 years under ground.Slide5
LUNG PATHOLOGY( Pigmented lesions )
Accumulation of dark pigment(coal dust) in alveolar MQ
>>
MQ activity
>>
inflamatory
changes
>>
product Reticolin >> MACULE (primary lesion in CWP ). Slide6
LUNG PATHOLOGY( Black lung )Slide7
MACULE
Destract
of alveolar walls Emphysema
Collagen
Scar
Dust deposition
Massive lesions
Cavitation Black liquidSlide8
Location of
macule
Primary lesion in upper lobe
,
upper segment
lower lobe .Slide9
Clinical manifestation
Simple CWP:
lesions in CXR
<10 mm
diameter
asymptomatic
Slide10
Clinical manifestation . . .
Complicated CWP (PMF): lesions in CXR
>10 mm
diameterSlide11
Clinical manifestation . . .
Complicated CWP (PMF):
Chronic Bronchitis:
chronic
couph
and productive sputum
Emphysema
Silicosis:
(due to silica)CWP and Silicosis often see in coal miner
Silicosis is pathologically distinct from CWP
Two disorders often cannot distinguished
radiographically
Mycobactrial
infection:
(TB ,other
mycobactrial
dx
due to silica )
Caplan
Sx
(Rheumatoid pneumoconiosis ):
CWP + RA(joint disorder ,
rheumatiod
nodule
)
Malignancy:
Lung cancer, gastric cancer, bladder, skin, scrotumSlide12
Pathologic
classification of coal mine
dust-induced changesSlide13
Imaging
CXR:
Simple CWP:
lesions
<10 mm
diameter(3-10 mm), round or irregular
Complicated CWP (PMF):
lesions
>10 mm
diameter
CXR is insensitive to early
pathologic
intrestitial
and emphysematous
changes.which
may be found pathologically or on HRCT with normal
routin
CXR.
May by visible
abnormal
in CXR whitout
clinical disease (preclinical stage) if remove Pt from exposure decrease progression of dx
.
if CWP whit silica exposure in CXR
hilar
LN calcification Slide14
CXR . . . Slide15
Complicated CWP (PMF)Slide16
Complicated CWP (PMF)Slide17
Emphysema
PMFSlide18
Cavitation
PMF
EmphysemaSlide19
Caplan
Sx (Rheumatoid pneumoconiosis )Slide20
Imaging . . .
CT scan:
for pneumoconiotic
nodules
and
PMF
, when they were not apparent on
routin
CXR .
HRCT: high sensitive for emphysema in early stage .
Gallium scan:
increased activity but not specific .
MRI:
no utility Slide21
Imaging . . . Slide22
PFT:
Simple CWP: no
significant
abnormality
Comlicated
CWP (PMF):
restrictive or mixed pattern
DLCo
ABG: hypoxia, hyper
capniaSlide23
Prognosis
Simple CWP:
benign course
Complicated CWP:
mild to sever respiratory symptoms and impairment Slide24
Prevention
1° prevention: decrease exposure
Dilution ventilation
Dust suppression
Increase fresh air
Water spray near the cutting head
RespiratorSlide25
Prevention . . .
2° prevention:
Examination
CXR
Spirometery
(decrease ≥ 15% FEV1 from baseline is significant )Slide26