Occupational Disorders Flip JK Amorosa

References

• Cox, W et al: State of the Art: Imaging of Occupational Lung Disease radiology 2014; 270: 681-696

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Pneumoconiosis beyond A and S

A sbestosis

A rdystil Syndrome B yssinosis C oal Workers Pneumoconiosis F lockworkers lung HMLD (Hard Metal Lung Disease) ITO (Indium-tin-oxide)

S ilicosis

S iderosis

Asbestos: mineral

Composition:

 Silicon  Oxygen  Hydrogen  Calcium  Sodium  Metals: magnesium, iron

Characteristics:

 Strength  Flexibility  Low electrical conductivity  Resistant to heat and chemicals  Greek origin means: inextinguishable, or indestructible

Asbestos

• • • fibrous mineral construction materials: roofing, siding shingles, pipe and boiler insulation, floor/ ceiling tiles carcinogen years following asbestos exposure

Asbestos

• undisturbed asbestos-containing materials: no

health risk

• damaged or disturbed, or deteriorate over time and release asbestos fibers into building air: health risk

Byssinosis (brown lung)

• Exposure to dust from cotton, hemp and flax • • Causes blockage of small airways ?? Endotoxin release from cell walls of Gm bacteria

Flockworkers lung disease

• • At Microfibres Inc in Rhode Island two young men developed interstitial lung disease Plant made carpet-like material for car upholstery. Workers cut long nylon strands into short nylon fibers called flock. The fragments were in the respirable size and were inhaled by the workers

Hard Metal Lung Disease(HMLD), also called Giant cell Interstitial Pneumonia (GIP) • • Characterized by “cannibalistic” multinucleated giant cells in airspaces on BAL Powdered tungsten carbide and cobalt • Called sintered carbides, hard as diamond

ITO Indium tin oxide

• Transparent , colorless, when deposited as a thin film on glass, it acts as an electrical conductor • Used for display technology: LCD, plasma, electroluminescent, touch screen technology

• • • Iron ore miners Welders Steel workers

Siderosis

• • • Fibrosis Obstructive airway disease Lung ca

Localized malignant mesothelioma (stage I)

• Unilateral parietal or visceral pleura and pericardium

Advanced malignant mesothelioma (stage II,stage III, and stage IV)

• • • • stage II, cancer in ipsilateral pleura, pericardium In stage III, cancer has spread to any of the following areas: – The chest wall. – The mediastinum. – The heart. – – Beyond the diaphragm. The peritoneum. Cancer may have also spread to lymph nodes on the other side of the chest or outside the chest.

In stage IV, cancer has spread to distant organs or tissues.

WHO

• • 200,000 people die each year from cancers related to their workplaces, mainly from inhaling asbestos fibers and second-hand tobacco smoke.

125 million people worldwide are exposed to asbestos at work and every 10th lung cancer death is related to occupational hazards, which amount to at least 90,000 deaths each year.

P N E U M O C O N I O S I S

• LUNG DUST

Occupational Lung Diseases

• Occupational lung diseases are caused by inhaled particles,mists, vapors or gases while at work.

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Occupations

Miners Millers Cement workers Construction Demolition Railroad workers Pipe fitters Shipyard workers Fertilizer manufacturers Brake repair Pharmaceuticals Diesel exhaust Fire fighters Aircraft workers               Plastics Explosives Fuels Welders Paint Bleach Chrome plating Paper industry Oil/ Petroleum Chemistry Dye Farmers Sewer cleaners Roofers Steel workers Ceramics Sanders Polishers Boiler makers Textiles Floor tilers Pigments Refinery workers Electronics Bricklayers US Navy Atomic energy Rubber

Asbestos Exposure

   in 3000 commercial products 1940 - 1979 US 27 million people occupational exposure to asbestos 7% were engaged in primary mining, milling, and manufacturing of asbestos products

Asbestos Related Pleural Disease

1. Plaque 2. Pleural effusion, benign 3. Rounded atelectasis****** 4. Mesothelioma

Asbestos Related Lung Disease: Asbestosis

• Asbestosis is the term reserved for pulmonary fibrosis caused by the inhalation of asbestos fibers. Subpleural lower lobes areas - mostly • Malignant masses: lung ca • Benign mass: rounded atelectasis, pleural thickening, mass contains low density centrally, has comet tail containing crowded vessels and bronchi

Pattern

• Silicosis- upper lung nodules • Asbestosis -lower lung linear opacities

Etiologies of Interstitial Pulmonary fibrosis include

1. Scleroderma 2. Idiopathic 3. Asbestosis 4. Silicosis

Asbestosis • HRCT: Septal and centrilobular thickening, long scars, parenchymal bands, subpleural lines, honeycombing • Radiograph: lower and mid lung zone reticulo-nodular process, causing “ shaggy ” heart border, honeycomb

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Development of lung disease is dependent on

Intensity of exposure Duration of exposure Physiologic and biologic susceptibility of host

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Acute

Inflammation Edema

Reactions

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Chronic

Fibrosis Granuloma

Pneumoconiosis - most common

• • • • • Asbestosis Berylliosis Byssinosis CWP (Coal Workers Pneumoconiosis) Silicosis

Kun –Kim et al November 2001 RadioGraphics, 21, 1371-1391.

Silicosis

  Small well-defined nodules of 2 to 5mm in diameter in both lungs Upper lobe predominance Nodules may be calcified Centrilobular and subpleural distribution Sometimes random distribution Irregular conglomerate masses, known as progressive massive fibrosis Often hilar and mediastinal lymphnodes.

Chart illustrates the descriptors from the 7th edition of the TNM staging system for lung cancer.

UyBico S J et al. Radiographics 2010;30:1163-1181

©2010 by Radiological Society of North America