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coal workers' pneumoconiosis
Epidemiology: coal workers
Pathology:
1) begins as anthracosis
2) coal macules
a) < 4 mm in size
b) consists of macrophages, fibroblasts, reticulin & collagen fibers
3) collections of coal macules around small airways cause bronchiolar dilatation & focal spongy emphysema
4) no increased risk of malignancy or tuberculosis
History:
- smoking
Clinical manifestations:
1) non-specific bronchitis may occur with inhalation of large amounts of coal dust
2) melanoptysis (expectoration of black sputum)
Special laboratory:
- pulmonary function testing:
1) generally normal unless the patient smokes
2) slight decrease in FEV1 may be related to centrilobular emphysema
3) distinguishes obstructive vs restrictive pattern if abnormal
Radiology:
- chest X-ray
a) tiny nodular infiltrates in the upper lung zones
b) micronodules (< 7 mm in diameter)
c) macronodules (> 7 mm in diameter)
Management:
- remove from exposure
Specific
anthracosis
hard metal pneumoconiosis; giant cell interstitial pneumonia; cobalt lung
General
occupational lung disease
References
- Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed)
Lippincott-Raven, Philadelphia, 1998, pg 759
- Medical Knowledge Self Assessment Program (MKSAP) 16,
American College of Physicians, Philadelphia 2012
- Kuempel ED, Wheeler MW, Smith RJ
Contributions of dust exposure and cigarette smoking to
emphysema severity in coal miners in the United States.
Am J Respir Crit Care Med. 2009 Aug 1;180(3):257-64
PMID: 19423717