• Clinical science

Rare pneumoconioses

Summary

Pneumoconioses are a group of restrictive interstitial lung diseases caused by the inhalation of certain dusts, which are often associated with mining and agriculture. Inhalation of inorganic dust – especially chronic, occupational exposure – causes an inflammatory reaction in the lung parenchyma, which may lead to symptoms such as cough and breathlessness. Typically, disease manifestation occurs after many years of exposure. An occupational history of patients with findings indicative of interstitial disease suffice to diagnose the condition. Chest x-ray serves as an adjunct diagnostic tool and allows the scarring associated with the disease to be visualized. There is no effective targeted therapy for pneumoconioses; management involves avoidance of triggers, supplemental oxygen, and supportive therapy. Prevention through screening programs, use of masks and adequate ventilation, and/or change of jobs can help lower the impact of the condition.

This card only covers rare forms of pneumoconiosis. For asbestosis and silicosis, see the respective cards.

Overview

Types of rare pneumoconioses

Type Cause Population at risk Characteristic features Chest x-ray
Aluminosis [2]
  • Aluminum dust
  • Welders (e.g., automobile industry)
  • Nodular or diffuse infiltrates (predominantly affects the upper lung fields)
  • Small cystic radiolucencies (“honeycombing”) [3]
Anthracosis [4][5]
  • Carbon dust and sooty air
  • City dwellers
  • Coal miners
  • More mild than other types of pneumoconiosis, usually asymptomatic
  • Pulmonary fibrosis rarely occurs.
  • Upper lobes of the lungs are primarily affected.
  • Heterogenous pulmonary infiltrates, with/without mass lesion
Coal workers' pneumoconiosis [4][5]
  • Prolonged exposure to large amounts of coal dust
  • Inflammation and fibrosis induced by carbon-laden macrophages
  • Fine nodular opacifications (< 1 cm) in upper lung zone
Berylliosis
  • Workers in manufacturing industries where alloys are frequently used (often high-tech)
    • Aerospace engineering
    • Nuclear and electronics plants
    • Ceramics industries
    • Dental material production
    • Dye manufacturing
Pulmonary siderosis [8][9]
  • Welders, iron miners, foundry workers
  • Usually asymptomatic; occasionally, presents with features similar to COPD
  • Pulmonary fibrosis rarely occurs.
  • Small, round, patchy shadows on x-ray

Although coal is mined from under the earth, the upper lobes of the lungs are primarily affected.

References:[10][3][5][11]

  • 1. Nemery B. Metal toxicity and the respiratory tract. Eur Respir J. 1990; 3(2): pp. 202–219. pmid: 2178966.
  • 2. Smolkova P, Nakladalova M. The etiology of occupational pulmonary aluminosis - the past and the present. Biomedical Papers. 2014; 158(4): pp. 535–538. doi: 10.5507/bp.2014.017.
  • 3. Smolková P, Nakládalová M, Tichý T, Hampalová M, Kolek V. Occupational pulmonary aluminosis: a case report. Ind Health. 2014; 52(2): pp. 147–151. doi: 10.2486/indhealth.2012-0154.
  • 4. Leonard R, Zulfikar R, Stansbury R. Coal mining and lung disease in the 21st century. Curr Opin Pulm Med. 2020; 26(2): pp. 135–141. doi: 10.1097/mcp.0000000000000653.
  • 5. Mirsadraee M. Anthracosis of the lungs: etiology, clinical manifestations and diagnosis: a review. Tanaffos. 2014; 13(4): pp. 1–13. pmid: 25852756.
  • 6. Dweik RA. Berylliosis Medication. In: Mosenifar Z. Berylliosis Medication. New York, NY: WebMD. https://emedicine.medscape.com/article/296759-medication. Updated December 31, 2015. Accessed April 22, 2020.
  • 7. Boffetta P, Fordyce TA, Mandel JS. A mortality study of beryllium workers. Cancer Medicine. 2016; 5(12): pp. 3596–3605. doi: 10.1002/cam4.918.
  • 8. Khalid I, Khalid TJ, Jennings JH. A welder with pneumosiderosis: a case report. Cases Journal. 2009; 2(1): p. 6639. doi: 10.1186/1757-1626-2-6639.
  • 9. Akar E, Yildiz T, Atahan S. Pulmonary siderosis cases diagnosed with minimally invasive surgical technique: A retrospective analysis of 7 cases. Annals of Thoracic Medicine. 2018; 13(3): p. 163. doi: 10.4103/atm.atm_152_17.
  • 10. Karkhanis VS, Joshi JM. Pneumoconioses. Indian J Chest Dis Allied Sci. 2013; 55(1): pp. 25–34. pmid: 23798087.
  • 11. Stark P, Muller NL, King Jr TE, Hollingsworth H, Lee SI. Imaging of Occupational Lung Diseases. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/imaging-of-occupational-lung-diseases. Last updated February 10, 2016. Accessed June 1, 2017.
last updated 09/23/2020
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