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Lung Pathology 2


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Lung disease associated with industries such as mining and milling of stones and ores, pottery,
How long must you be exposed to Silica b4 presenting?
20-40 yrs
small nodules on CXR scattered throughout lungs; 5-10% have “eggshell
hilar LN calcifications; usu asymptomatic. Starts in upper lobes on CXR.
Simple Silicosis
conglomerates of silicotic nodules >1cm in diameter; respiratory
complaints common
Complicated silicosis:
Caplan’s syndrome:
formation of large necrotic rheumatoid nodules in lungs of pts. with
silicosis who develop RA (rheumatoid arthritis); silicotic nodules undergo necrosis
T/F, Individuals with Silicosis have a higher risk of developing TB
TRUE. Silicotuberculosis: # risk of TB in pts with pneumoconiosis, esp. silicosis
A sandblaster takes NO respiratory precaution one day while working. What lung disease does he present with?
Acute Silicosis
insulation workers, fireproofers, workers in brake linings, are all at risk for this lung disease
Asbestosis, (must have 10-20 yrs of exposure)
5 clinical manifestations of Asbestosis
-Recurrent pleural effusions
-Pleural fibrosis and hyaline plaques (benign)
-Bronchogenic carcinoma
-Malignant mesothelioma
What do Asbestos bodies look like?
dumbells, (they take up Iron)
Exposure to coal dust; if the coal dust has significant
amounts of silica, silicosis may be superimposed on this condition
Coal Workers Pneumoconiosis
Name the 3 Clinical Forms of CWP (Coal Workers Pneumoconiosis)
-simple CWP - asymp. exp for black sputum
-Progressive Massive Fibrosis (Complicated CWP)
-Typical Nodular lesions of silicosis (May or may not be superimposed with above CWP effects)
You meet a fluorescent light bulb maker with respiratory problems. He also has some nuclear
and aerospace industry buddies that have similar lung problems. What does he have?
Acute - hypersensitivity rxn. to beryllium;
Chronic berylliosis: identical to sarcoid under LM;
4 Radiographic Stages of Sarcoidosis
Bilateral hilar lymphadenopathy without infiltrates; lymph nodes are so big they’re sometimes
likened to potatoes; PFTs are often normal at this point, but as the disease progresses into the
other stages there will be the characteristic changes of restrictive lung disease
2. Bilat. hilar lymphadenopathy with interstitial infiltrates
3. Interstitial infiltrates only (less enlarged hilar LN because of scarring)
4. Honeycomb lung
Clinical course: variable
Sarcoidosis can have effects throughout the body. Name them:
Heart, GI, GU, eytes, Skin, PNS, CNS, endocrine, Skeletal
heart: heart block, arrhythmia, failure; or cor pulmonale due to lung fibrosis
GI: hepatic granulomas, # alk phos
GU: # serum Ca++ ! hypercalciuria ! kidney stones
eyes: uveitis and retinopathy, blurry vision, eye pain, blindness
skin: erythema nodosum, erythema multiforme – signs of early disease and good prognosis
plaque-like nodules and facial nodules are signs of chronic, progressive disease and carry a poor
PNS: peripheral neuropathy, facial nerve palsy
CNS: cerebrum, cerebellum, brainstem, spinal cord lesions – can see these w/ minimal/no evidence
of thoracic dz.
endocrine: hypercalcemia due to activation of vit D by macrophages, hypopituitarism, diabetes
skeletal: arthritis, arthralgia, bone cysts
A patient has Erythema Nodosum and Erythema Multiforme. What dz? Any idea about prognosis?
Noncaseating granulomas in a young African-American woman. Stains and cultures are negative
Why is it important to rule out infectious causes when diagnosing Sarcoidosis
Because txt is immunosuppressive and could exacerbate an undetected infection.
Name 7 causes of Intersitial Lung Disease
- Autoimmune diseases: RA, MCTD, Scleroderma
- Drug toxicities: ChemoTx: Bleomycin, Amiodarone
- Environmental toxins: Asbestos, Silica
- Sarcoidosis
- Hypersensitiviy Pneumonitis
- Eosinophilic Granuloma (HX)
- Idiopathic Pulmonary Fibrosis (IPF)
Name Symptoms of CISLD
weight loss
dry rales
clubbing – chronic hypoxia
PFTs – decreased volume (RESTRICTIVE pattern), decreased
No consolidation on CXR; tympanic on auscultation

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